Abstract: Urinary incontinence (UI) primary care management is substandard, offering care rather than cure despite the existence of guidelines that help to improve cure. Involving nurse specialists on incontinence in general practice could be a way to improve care for UI patients.
Abstract: To explore experiences and attitudes of nurse specialists in primary care regarding their role in care for patients with urinary incontinence (UI), thereby identifying facilitators and barriers for wider implementation.
Abstract: BACKGROUND: Urinary incontinence is a common problem, affecting quality of life and leading to high costs. There is doubt about the use of clinical practice guidelines on urinary incontinence in primary care. OBJECTIVE: To assess adherence levels and reasons for (non)adherence to the Guideline on Urinary Incontinence of the Dutch College of General Practitioners. Design, setting and participants A postal survey among Dutch general practitioners (GPs). MAIN OUTCOME MEASURE: Adherence of GPs to the guideline. RESULTS: We analysed 264 questionnaires. Almost all GPs adhered to the guideline when diagnosing the type of urinary incontinence. A bladder diary is not often used (35%). Adherence to therapeutic procedures was only high for mild/moderate stress urinary incontinence: most GPs (82.6%) used adequate advice on bladder retraining and pelvic floor muscle training. One out of four GPs agreed that adhering to the guideline is difficult, mainly owing to lack of time, staff, diagnostic tools, competences to provide this care and low motivation of patients. CONCLUSIONS: Dutch GPs follow the guideline only partially: compliance with diagnostic advices is fairly good; compliance with treatment advices is low. Further research should focus on solutions how to support GPs to tackle major barriers to facilitate the adherence to guidelines (substitution of tasks to specialized nurses, reducing the threshold for referral and concentrating expertise in integrated continence care services).
Abstract: BACKGROUND: Urinary incontinence affects approximately 5% (800.000) of the Dutch population. Guidelines recommend pelvic floor muscle/bladder training for most patients. Unfortunately, general practitioners use this training only incidentally, but prescribe incontinence pads. Over 50% of patients get such pads, costing 160 million euros each year. Due to ageing of the population a further increase of expenses is expected. Several national reports recommend to involve nurse specialists to support general practitioners and improve patient care. The main objective of our study is to investigate the effectiveness and cost-effectiveness of involving nurse specialists in primary care for urinary incontinence. This paper describes the study protocol. METHODS/DESIGN: In a pragmatic prospective multi centre two-armed randomized controlled trial in the Netherlands the availability and involvement for the general practitioners of a nurse specialist will be compared with usual care. All consecutive patients consulting their general practitioner within 1 year for urinary incontinence and patients already diagnosed with urinary incontinence are eligible. Included patients will be followed for 12 months.Primary outcome is severity of urinary incontinence (measured with the International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI SF)). Based on ICIQ-UI SF outcome data the number of patients needed to include is 350. For the economic evaluation quality of life and costs will be measured alongside the clinical trial. For the longer term extrapolation of the economic evaluation a Markov modelling approach will be used. DISCUSSION/CONCLUSION: This is, to our knowledge, the first trial on care for patients with urinary incontinence in primary care that includes a full economic evaluation and cost-effectiveness modelling exercise from the societal perspective. If this intervention proves to be effective and cost-effective, implementation of this intervention is considered and anticipated. TRIAL REGISTRATION: Current Controlled Trials ISRCTN62722772.
Abstract: BACKGROUND: Urinary incontinence (UI) is a widespread problem, affecting quality of life and leading to high costs, mainly caused by incontinence pads. It seems that, despite guidelines, many UI patients get pads from their general practitioner (GP) without adequate diagnostics or treatment. OBJECTIVES: To assess what further treatment UI patients receive from their GP next to pads and to measure patient satisfaction with care. METHODS: A postal survey among UI patients who started pad use in the past 12 months. MAIN OUTCOME: Satisfaction with UI care. Results: We analysed 208 questionnaires. 29.3% of pad users had no direct contact with their GP for a pad prescription. Of 147 UI patients who visited their GP 50.3% only got pads. 25% of patients was not satisfied with the information on UI received from their GP, especially younger patients, women, less healthy patients and patients with urgency UI. CONCLUSIONS: Dutch UI patients using pads experience suboptimal GP care and management. Factors identified through patient feedback should be used to improve quality of care for UI in primary care.
Abstract: The objective of this study was to test the short- and long-term effects of pelvic floor muscle training (PFMT) during pregnancy in women at risk, i.e. women who were already affected by urinary incontinence (UI) during pregnancy. The intervention consisted of three sessions of PFMT between week 23 and 30 during pregnancy and one session 6 weeks after delivery, combined with written information. The research design was a randomised, controlled trial with four follow-ups up to 1 year after delivery. Participants in the study were 264 otherwise healthy women with UI during pregnancy, allocated at random to the intervention (112) or usual care (152) group. The main outcome measure was a UI severity scale and a 7-day bladder diary. No effect of pelvic floor muscle training was shown in this study at (half) a year after pregnancy. UI decreased strongly after pregnancy, irrespective of usual care or PMFT during pregnancy. For most women, usual care appears to be sufficient. The results support a 'wait and see' policy: wait for the urinary incontinence to take its natural course and see if, for women still incontinent half a year after pregnancy, pelvic floor muscle training is effective.
Abstract: Ongewild urineverlies komt veel voor. De kosten voor incontinentiemateriaal zijn hoog: jaarlijks 166 miljoen euro. Het aantal patiënten neemt toe met de vergrijzing en daardoor ook de kosten. Bij adequate behandeling in de eerste lijn, zouden deze kosten flink lager uit kunnen vallen. Uit deze studie blijkt dat taakondersteuning door gespecialiseerde urine-incontinentie verpleegkundigen voor huisartsen een betere kwaliteit van incontinentiezorg oplevert tegen een acceptabele prijs. Patiënten bleken erg tevreden over de zorg door de verpleegkundigen, die op hun beurt weer tevreden waren met hun nieuwe taken. Het merendeel van de huisartsen vond de rol van de verpleegkundige nuttig. Op basis van deze studieresultaten wordt aanbevolen deze manier van hulpverlening in de eerste lijn op grotere schaal in te voeren, en te vergelijken met andere, concurrerende manieren van incontinentiezorg. Dit levert in de toekomst meer informatie op voor de besluitvorming betreffende vergoedingen voor de incontinentiezorg.
Abstract: Background
Urinary incontinence is a common problem, affecting quality of life and leading to high costs. There is doubt about the use of clinical practice guidelines on urinary incontinence in primary care.
Aim(s)
To assess adherence levels and reasons for (non)adherence to the Guideline on Urinary Incontinence of the Dutch College of General Practitioners.
Design and methods
A postal survey among Dutch general practitioners (GPs).
Main outcome measure is adherence of GPs to the Guideline.
Results
We analysed 264 questionnaires.
Almost all GPs adhered to the guideline when diagnosing the type of urinary incontinence. A bladder diary is not often used (35%). Adherence to therapeutic procedures was only high for mild/moderate stress urinary incontinence: most GPs (82.6%) used adequate advice on bladder retraining and pelvic floor muscle training. One out of four GPs agreed that adhering to the guideline is difficult, mainly due to lack of time, staff, diagnostic tools, competences to provide this care and low motivation of patients.
Conclusions
Dutch GPs follow the guideline only partially: compliance with diagnostic advices is fairly good; compliance with treatment advices is low. Further research should focus on solutions how to support GPs to tackle major barriers to facilitate the adherence to guidelines (substitution of tasks to specialized nurses, reducing the threshold for referral and concentrating expertise in integrated continence care services).
Abstract: The prevalence of urinary incontinence (UI) is considerable, and it seriously afffects the health-related quality of life of adults, predominantly women.
Incontinence becomes more prevalent with age, it is often complicated by co-morbidities and it is one of the most important reasons for the early admission of elderly
people into hospitals or nursing homes. As the world’s population ages, important public health and clinical management implications have to be considered over the next decade to effectively prevent and manage this condition. Despite the high prevalence estimates and clear guidelines on the initial assessment and treatment of UI in primary care, awareness and understanding of UI among the general public, health professionals and health service planners are poor compared to other non lifethreatening conditions. As a result of which many people are currently receiving inadequate treatment. Doubts about the quality, efficiency and organisation of UI care and the increasing socio-economic burden imposed by UI on the healthcare system, mean that it is becoming ever more important to find solutions to improve all aspects of UI care. Revision of professional roles is seen as a viable strategy to consider when addressing challenges facing healthcare over the coming decades.
The research reported on in this thesis showed that the involvement of nurse specialists in primary UI care is feasible and leads to favourable effects on the outcomes and
cost-effectiveness of care for adult UI patients, compared to care-as-usual. Based on these results, and taking into account that the implementation costs are likely to be low, we recommend adopting the nurse specialist intervention in primary care, while conducting further research to reduce uncertainty. Careful monitoring of the performance of the intervention with suitable recording of real world data will allow for longer follow-up with future evidence development and will yield further information for coverage decisions.
Abstract: Who cares? Wiens zorg is het: hulp bij incontinentie? Een probleem dat, met het oog op de vergrijzing, steeds meer zal toenemen en daarmee ook de kosten. Bij adequate behandeling in de eerste lijn zouden de kosten (die alleen al voor incontinentiemateriaal jaarlijks oplopen tot 166 miljoen euro) flink lager uit kunnen vallen.
Pytha Albers-Heitner, gezondheidswetenschapper en bekkenfysiotherapeut promoveerde op 1 december 2012 op een onderzoek naar de effecten van het inschakelen van een incontinentie gespecialiseerd verpleegkundige in de huisartspraktijk.
De meest voorkomende incontinentievormen kunnen na een goede diagnose, bewezen effectief behandeld worden volgens de huisartsrichtlijn, met o.a. advies over leefstijl, toiletgedrag en trainen van blaas en bekkenbodem. Incontinentie heeft echter vaak geen prioriteit en door gebrek aan tijd is een recept voor incontinentiemateriaal
snel voorgeschreven. De studies in dit proefschrift tonen aan dat taakondersteuning door gespecialiseerde urine-incontinentie verpleegkundigen voor huisartsen een betere
kwaliteit van incontinentiezorg oplevert tegen een acceptabele prijs. Patiënten bleken erg tevreden over de zorg door de verpleegkundigen. Ook het merendeel van de huisartsen vond de rol van de verpleegkundige nuttig. Op basis van deze studieresultaten wordt dan ook aanbevolen deze manier van hulpverlening in de eerste lijn op grotere schaal in te voeren samen met onderzoek, waaronder een representatieve steekproef uit alle, concurrerende manieren van incontinentiezorg,
waarbij de resultaten steeds op dezelfde manier worden gemonitored en herbeoordeeld. Dit levert in de toekomst meer informatie op voor de besluitvorming betreffende vergoedingen voor de incontinentiezorg.
Het proefschrift is op te vragen bij: c.albers@maastrichtuniversity.nl
Abstract: Naast deze resultaten staan de bevindingen van een gerandomiseerde Nederlandse studie uitgevoerd in de huisartspraktijk bij patiënten met urine incontinentie (Albers-Heitner et al.: cost effectiveness of involving nurse specialists for adult patients with urinary incontinence in primary care: Abstract 168) Groep I, n=186 werd begeleid en behandeld door een nurse-specialist (continentie verpleegkundige). Groep II, n=198, ontving care-as-usual d.w.z. informatiebrief en mondelinge uitleg. In dit onderzoek blijkt dat actieve interventie weliswaar duurder is maar ook kosten effectief, met name wanneer de (subjectieve) beoordeling van de patiënt wordt meegewogen.
