Donegal going against the flow: Irish differences in long-term urinary catheterisation (LTC) rates in men with Benign Prostatic Hypertrophy (BPH).

Abstract

Donegal is a geographically removed county on the northwest coast of Ireland. It is known to have high levels of social deprivation¹.Feedback from both hospital and general practice (GP) colleagues indicate that there appears to be a high proportion of men in Donegal with long-term urinary catheters (LTCs). There is a perceived difficulty accessing Urology services for public (GMS) patients in Donegal.A retrospective analysis of Primary Care Reimbursement Service (PCRS) data (2013) was carried out which demonstrated:Total urinary catheter insertions in men over 65 years of age (2013): Donegal 907 ; Kerry 282; Dublin South 33; Dublin West 28; Waterford 1612.This gives a crude 2.55% rate for male GMS patients in Donegal greater than 65 years of age for urinary catheter insertions compared to Dublin South: 0.045% ;Waterford: 0.63 % ; NICE > 75yrs: 0.5%3.For the patients sampled in Donegal, The average duration since 1st urinary catheter insertion was 53 months. 89% of the patients had been referred to Urology. The mean wait for Urology review was 43.75 months. The mean patient age was 80 years. (21%) were based in a nursing home and (79%) were in the community.Differences in LTC rates in the population sampled in Donegal (Rural), Leinster (Urban) and Waterford (Suburban) were significant 1.41% (95% CI 1.0203 – 1.7958) (P < 0.0001) and 1.81% (95% CI 14840 – 2.1549) ( P < 0.0001) respectively.For many reasons Donegal has struggled with service provision particularly in services like Urology. Could this anomaly in LTC rates be a useful parameter to measure the quality and provision of local health services?