Perspective of Dutch healthcare professionals on care for female urinary incontinence: a mixed-methods study.

Abstract

Urinary incontinence (UI) impacts patients and society in many ways. There are good treatment options, but healthcare delivery and processes are often suboptimal. Healthcare professionals (HCPs) can reveal practical recommendations to improve processes and address challenges in the care of women with UI in the Netherlands. We conducted an exploratory, sequential, mixed-methods study among HCPs, using outcomes of five focus group sessions (30 HCPs) to inform a subsequent survey. HCPs included GPs, practice assistants (PAs), pelvic physiotherapists (PPTs), and urologists and gynecologists (UGs). Main themes arising from the five focus group sessions (with six GPs, seven PAs, six (resident) UGs, eight PPTs, and seven PPTs) were 'identification of UI', 'current state of care', and 'guiding patients through the healthcare system'. Survey responders (n = 741) included 351 PAs, 124 GPs, 75 PPTs, and 183 UGs. Overall, 72.8% (strongly) agreed that the identification of UI required improvement and 60% confirmed the need for further education. Most HCPs (83.1%) found it useful to offer a patient information leaflet when buying incontinence products but less useful to ask about UI routinely, and most (75%) agreed that a multidisciplinary guideline could improve health care. Interestingly, 86% of PPTs and 21% of UGs advocated referral to a PPT before referral to a specialist, while 87% of PPTs wanted primary care services to offer a UI consultation hour and 36% of the GPs (strongly) disagreed. Poor UI identification in primary care and a lack of patient guidance through the healthcare system hamper continence care provision.