Department of Integrated Care, Maastricht University Medical Centre, Maastricht, The Netherlands.
Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Health Organisation, Policy, and Economics, Maastricht University Medical Centre, Maastricht, The Netherlands; Pelvic care Centre Maastricht (PcCM), Maastricht University Medical Centre, Maastricht, The Netherlands; Poliklinisch Continentie Centrum, HAGA Hospital, The Hague, The Netherland; Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Department of General Practice, Maastricht University Medical Centre, Maastricht, The Netherlands.
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.
We studied whether involving nurse specialists on UI in general practice reduced severity and impact of UI.
Between 2005 and 2008 a pragmatic multicentre randomised controlled trial was performed comparing a 1-year intervention by trained nurse specialists with care-as-usual after initial diagnosis and assessment by general practitioners in adult patients with stress, urgency or mixed UI in four Dutch regions (Maastricht, Nijmegen, Helmond, The Hague). Simple randomisation was computer-generated with allocation concealment. Analysis was performed by intention-to-treat principles. Main outcome measure was the International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI SF) severity sum score.
A total of 186 patients followed the intervention and 198 received care-as-usual. Patients in both study groups improved significantly in UI severity and impact on health-related quality of life. After correction for effect modifiers [type of UI, body mass index (BMI)], we found significant differences between groups in favour of the intervention group at 3 months (p = 0.04); no differences were found in the 1-year linear trend (p = 0.15). Patients in the intervention group without baseline anxiety/depression improved significantly better compared with care-as-usual after 1 year (p = 0.03).
Involving nurse specialists in care for UI patients supplementary to general practitioners can improve severity and impact of UI, after correction for effect modifiers. This is also the case in specific situations such as anxiety/depression.
Written by:
Albers-Heitner CP, Lagro-Janssen AL, Joore MA, Berghmans LC, Nieman F, Venema PL, Severens JL, Winkens RA. Are you the author?
Reference: Int J Clin Pract. 2011 Jun;65(6):705-712.
doi: 10.1111/j.1742-1241.2011.02652.x
PubMed Abstract
PMID: 21564445
UroToday.com Urinary Incontinence (UI) Section
