Abstract
BackgroundGlobal demographic trends suggest that the incidence of both urinary and faecal incontinence will rise in the coming years, bringing significant health and economic implications for both patients and payers. There is limited organisational evidence to guide payers and providers about service configuration which will deliver efficient guideline-compliant, high-quality patient care.ObjectivesTo create, using evidence from a systematic review, qualitative data and expert consensus an internationally applicable service specification for continence care.MethodEvidence was obtained from a systematic and grey literature review of published randomised controlled trials and quasi-experimental studies reporting efficacy of continence service design at the level of the community dwelling patient with either bladder or bowel incontinence, governmental reports and policy frameworks supplemented by data from 47 semi-structured interviews with clinicians, patients, patient-representatives and policy experts from four geographies broadly representative of different healthcare systems.ResultsA number of themes related to current and potential future organisation of continence care were identified from the data. A modular service specification with eight core components was created including case detection, initial assessment and treatment, case co-ordination, caregiver support, community-based support, specialist assessment and treatment, use of containment products, and use of technology. Within this framework important key recommendations are: ensure robust referral pathways, shift assessment for case coordination to nurses specializing in continence care, promote self-management and technology, use comprehensive assessment tools and service performance targets based on outcome and operational measures.ConclusionsThis study has defined practice gaps in the provision of continence services and described eight core components of a service specification for incontinence that commissioners and payers of health and social care could consider using to provide high-quality continence care. A shift towards a community-delivered, nurse-led model appears to be associated with clinical and cost-effective care for people with bladder and bowel incontinence.
Highlights
Global demographic and clinical trends suggest that the incidence of both urinary and faecal incontinence will rise sharply in the coming years with significant health and economic implications for both patients and payers [1]
Impact The prevalence of urinary incontinence (UI) in communitydwelling middle-aged and older women is estimated to be between 30% and 60% depending on definition and the population in which the study occurred [4,5,6,7,8], while the pooled overall prevalence rates of UI in community-dwelling men range from 5% to 32% [1]
A more recent study in Taiwanese women has confirmed the greater impact of incontinence on quality of life compared with other major chronic conditions [12]
Summary
Global demographic and clinical trends suggest that the incidence of both urinary and faecal incontinence will rise sharply in the coming years with significant health and economic implications for both patients and payers [1]. There is limited evidence to guide payers and providers about how continence care might best be configured to deliver efficient, guideline-compliant, high-quality patient care at either the same, or lower, overall cost [3]. Global demographic trends suggest that the incidence of both urinary and faecal incontinence will rise in the coming years, bringing significant health and economic implications for both patients and payers. There is limited organisational evidence to guide payers and providers about service configuration which will deliver efficient guidelinecompliant, high-quality patient care. Available evidence from the literature confirmed that, compared with other common chronic illnesses, incontinence has a major impact on quality of life
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