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Abraham K, Kanters TA, Wagg AS, Huige N, Hutt E, Al MJ. Benefits of a digital health technology for older nursing home residents. A de-novo cost-effectiveness model for digital health technologies to aid in the assessment of toileting and containment care needs. PLoS One 2024; 19:e0295846. [PMID: 38166006 PMCID: PMC10760782 DOI: 10.1371/journal.pone.0295846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 11/30/2023] [Indexed: 01/04/2024] Open
Abstract
The aim of this study was first, to introduce a comprehensive, de-novo health economic (HE) model incorporating the full range of activities involved in toileting and containment care (T&CC) for people with incontinence, capturing all the potential benefits and costs of existing and future Digital Health Technologies (DHT) aimed at improving continence care, for both residential care and home care. Second, to use this novel model to evaluate the cost-effectiveness of the DHT TENA SmartCare Identifi in the implementation of person-centred continence care (PCCC), compared with conventional continence care for Canadian nursing home residents. The de-novo HE model was designed to evaluate technologies across different care settings from the perspective of several stakeholders. Health states were based on six care need profiles with increasing need for toileting assistance, three care stages with varying degrees of toileting success, and five levels of skin health. The main outcomes were incremental costs and quality-adjusted life years. The effectiveness of the TENA SmartCare Identifi was based primarily on trial data combined with literature and expert opinion where necessary. Costs were reported in CAD 2020. After 2 years, 21% of residents in the DHT group received mainly toileting as their continence care strategy compared with 12% in the conventional care group. Conversely, with the DHT 15% of residents rely mainly on absorbent products for incontinence care, compared with 40% with conventional care. On average, residents lived for 2.34 years, during which the DHT resulted in a small gain in quality-adjusted life years of 0.015 and overall cost-savings of $1,467 per resident compared with conventional care. Most cost-savings were achieved through reduced costs for absorbent products. Since most, if not all, stakeholders gain from use of the DHT-assisted PCCC, widespread use in Canadian residential care facilities should be considered, and similar assessments for other countries encouraged.
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Affiliation(s)
- Katharina Abraham
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Tim Andre Kanters
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Adrian Stuart Wagg
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Gothenburg Continence Research Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nicole Huige
- Essity Hygiene and Health AB, Gothenburg, Sweden
| | - Edward Hutt
- Medica Market Access Ltd, Tonbridge, United Kingdom
| | - Maiwenn Johanna Al
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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2
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Huion A, De Witte N, Everaert K, Halfens RJG, Schols JMGA. Care dependency and management of urinary incontinence in nursing homes: A descriptive study. J Adv Nurs 2020; 77:1731-1740. [PMID: 33277758 DOI: 10.1111/jan.14702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/30/2020] [Accepted: 11/13/2020] [Indexed: 11/29/2022]
Abstract
AIM To explore the differences in managing urinary incontinence in residents in nursing homes aged 65 years or older in relation to their care dependency. DESIGN The 2015 data of the Dutch annual independent (Inter)national Prevalence Measurement of Quality of Care of Maastricht University were used. The design involved a cross-sectional, multi-centre point prevalence measurement in hospitals, care homes, and home care. METHODS Secondary data analysis on the data provided by care home organizations. RESULTS In the care independent group, the solely use of absorbing material was the mostly applied intervention. In the group of care dependent persons, the combination of absorbing material with toilet on set times and on individual basis was the most common approach. CONCLUSION The outcome of this study indicated that the management of urinary incontinence in residents in nursing homes differs depending on their care dependency. IMPACT Caregivers in nursing homes should be aware of preferences of residents regarding the management of their urinary incontinence. Researchers should investigate criteria used by caregivers and care receivers into the decision of the application of interventions for urinary incontinence.
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Affiliation(s)
- Anja Huion
- School of Healthcare, HOGENT University of Applied Sciences and Arts, Ghent, Belgium
| | - Nico De Witte
- School of Healthcare, HOGENT University of Applied Sciences and Arts, Ghent, Belgium.,Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Gent, Belgium.,Department of structure and repair, Ghent University, Gent, Belgium
| | - Ruud J G Halfens
- Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Jos M G A Schols
- Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
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Gibson W, Johnson T, Kirschner-Hermanns R, Kuchel G, Markland A, Orme S, Ostaszkiewicz J, Szonyi G, Wyman J, Wagg A. Incontinence in frail elderly persons: Report of the 6th International Consultation on Incontinence. Neurourol Urodyn 2020; 40:38-54. [PMID: 33085806 DOI: 10.1002/nau.24549] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Evidence-based guidelines for the management of frail older persons with urinary incontinence are rare. Those produced by the International Consultation on Incontinence represent an authoritative set of recommendations spanning all aspects of management. AIMS To summarize the available evidence relating to the management of urinary incontinence in frail older people published since the 5th International Consultation on Incontinence. MATERIALS AND METHODS A series of systematic reviews and evidence updates were performed by members of the working group to update the 2012 recommendations. RESULTS Along with the revision of the treatment algorithm and accompanying text, there have been significant advances in several areas of the management of lower urinary tract symptoms in frail older people. DISCUSSION The committee continues to note the relative paucity of data concerning frail older persons and draw attention to knowledge gaps and research opportunities. Clinicians treating older people with lower urinary tract symptoms should use the available evidence from studies of older people combined with careful extrapolation of those data from younger subjects. Due consideration to an individual's frailty and wishes is crucial.
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Affiliation(s)
- William Gibson
- Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Theodore Johnson
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - George Kuchel
- UConn Center on Aging, University of Connecticut, Farmington, Connecticut, USA
| | - Alayne Markland
- Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Susie Orme
- Care of the Elderly Department, Barnsley Hospital NHS Foundation Trust, Barnsley, UK
| | - Joan Ostaszkiewicz
- Director of Aged Care, National Ageing Research Institute, Melbourne, Victoria, Australia
| | - George Szonyi
- Department of Geriatric Medicine, Balmain Hospital, Sydney, New South Wales, Australia
| | - Jean Wyman
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Adrian Wagg
- Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
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4
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Fader M, Cottenden A, Chatterton C, Engqvist H, Eustice S, Newman DK, Ostaszkiewicz J, Palmer MH, Willson T, Haylen B. An International Continence Society (ICS) report on the terminology for single-use body worn absorbent incontinence products. Neurourol Urodyn 2020; 39:2031-2039. [PMID: 32914896 DOI: 10.1002/nau.24488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 11/06/2022]
Abstract
AIMS In 2016, the International Continence Society (ICS) Standardization Steering Committee appointed a working group to address the confusing plethora of synonyms currently used to describe single-use body worn absorbent incontinence products by recommending preferred terminology. METHODS An online questionnaire was posted in 2016/17 inviting input from stakeholders internationally. The data were analyzed and conclusions progressively refined through working group discussions, an open meeting at the 2017 annual ICS conference, and a review of further iterations-including from the parent ICS Standardization Committee-until consensus was reached. Partway in, the International Organization for Standardization started a project with similar scope and the two organizations liaised to harmonize their conclusions while respecting each other's processes. RESULTS A hundred people from 18 countries responded to the questionnaire. About a third (32.2%) of those declaring their nationality were from the UK and a further third (34.5%) from other English-speaking countries. Two-thirds (67.8%) lived in Europe; around a quarter (23%) in North America; and 9.2% in Australasia. Seven main design categories of products were identified and, while clear consensus was readily achieved in naming some of them, others required more work to determine the best term among multiple contenders. CONCLUSIONS The working group concluded that the seven product design categories should be called: (a) pads; (b) unbacked pads; (c) male pads; (d) male pouches; (e) pull-on pads (protective underwear); (f) all-in-ones (wrap-around pads, adult briefs); and (g) belted pads (belted products), in which the bracketed terms are judged acceptable (though not preferred) alternatives.
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Affiliation(s)
- Mandy Fader
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Alan Cottenden
- Department of Medical Physics and Bioengineering, University College London, London, UK
| | | | | | - Sharon Eustice
- Bladder & Bowel Specialist Service, Cornwall Partnership NHS Foundation Trust, Bodmin, UK
| | - Diane K Newman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Mary H Palmer
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Bernard Haylen
- Faculty of Medicine, University of New South Wales, Sydney, Australia
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5
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Yates A. Understanding incontinence in the older person in community settings. Br J Community Nurs 2019; 24:72-76. [PMID: 30698472 DOI: 10.12968/bjcn.2019.24.2.72] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ann Yates
- Director of Continence Services, Cardiff and Vale University Health Board, Wales
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6
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Wagg A, Gove D, Leichsenring K, Ostaszkiewicz J. Development of quality outcome indicators to improve the quality of urinary and faecal continence care. Int Urogynecol J 2018; 30:23-32. [PMID: 30327849 PMCID: PMC6514083 DOI: 10.1007/s00192-018-3768-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/11/2018] [Indexed: 12/17/2022]
Abstract
Introduction and hypothesis Despite the range of treatment options available, relatively few people with incontinence find a total cure. The importance of daily management with toileting and containment cannot be underestimated. To our knowledge, there are no outcome measures to benchmark good care. The aim of this study was to create a set of key performance indicators (KPIs) to measure outcomes for toileting and containment. Methods An expert panel (EP) defined a set of KPIs using evidence from a scoping review, stakeholder engagement, and expert consensus. Peer reviewed articles, high-quality grey literature and international and national standards were reviewed to identify existing measures for management. These findings were augmented by an exercise involving patients, caregivers, nurses, clinicians, payers, policy makers and care providers to prioritise the findings and identify additional areas of interest. Results The final set of 14 KPIs includes quality indicators of process and outcome for those managed with a toileting and containment strategy and is relevant for both care-independent and -dependent persons. Rates of assessment, days waiting for specialist assessment, rates of return to work and those rating their quality of life as good or acceptable are captured. An indicator of well-being for caregivers and the economic costs of poor care are also defined. Conclusions The set of KPIs to measure outcomes from toileting and containment strategies describes the components of each to encourage integration into existing quality frameworks. Each KPI has been refined and detailed to encourage this. If implemented, resulting benchmarking data will facilitate care quality improvement and inform value-based care procurement and provision of toileting and containment strategies. Electronic supplementary material The online version of this article (10.1007/s00192-018-3768-2) contains supplementary material, which is available to authorized users
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Affiliation(s)
- Adrian Wagg
- Department of Medicine, University of Alberta, Edmonton, AB, Canada. .,Division of Geriatric Medicine, University of Alberta, 1-198, Clinical Sciences Building, 11350 - 83 Avenue, Edmonton, Alberta, T6G 2P4, Canada.
| | - Dianne Gove
- Alzheimer Europe, Luxembourg City, Luxembourg
| | - Kai Leichsenring
- European Centre for Social Welfare Policy and Research Vienna, Vienna, Austria
| | - Joan Ostaszkiewicz
- Centre for Quality and Patient Safety Research, Deakin University, Geelong, Australia
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7
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Abstract
Urinary incontinence symptoms are highly prevalent among women, have a substantial effect on health-related quality of life and are associated with considerable personal and societal expenditure. Two main types are described: stress urinary incontinence, in which urine leaks in association with physical exertion, and urgency urinary incontinence, in which urine leaks in association with a sudden compelling desire to void. Women who experience both symptoms are considered as having mixed urinary incontinence. Research has revealed overlapping potential causes of incontinence, including dysfunction of the detrusor muscle or muscles of the pelvic floor, dysfunction of the neural controls of storage and voiding, and perturbation of the local environment within the bladder. A full diagnostic evaluation of urinary incontinence requires a medical history, physical examination, urinalysis, assessment of quality of life and, when initial treatments fail, invasive urodynamics. Interventions can include non-surgical options (such as lifestyle modifications, pelvic floor muscle training and drugs) and surgical options to support the urethra or increase bladder capacity. Future directions in research may increasingly target primary prevention through understanding of environmental and genetic risks for incontinence.
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Affiliation(s)
- Yoshitaka Aoki
- Department of Urology, University of Fukui Faculty of Medical Sciences, Fukui, Japan
| | - Heidi W Brown
- Departments of Obstetrics and Gynecology &Urology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Linda Brubaker
- Department of Reproductive Medicine, University of California San Diego, San Diego, California, USA
| | - Jean Nicolas Cornu
- Department of Urology, Charles Nicolle Hospital, University of Rouen Normandy, Rouen, France
| | - J Oliver Daly
- Department of Obstetrics and Gynaecology, Western Health, Victoria, Australia
| | - Rufus Cartwright
- Department of Urogynaecology, St Mary's Hospital, London, UK
- Department of Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London W2 1PG, UK
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Ostaszkiewicz J. Reframing continence care in care-dependence. Geriatr Nurs 2017; 38:520-526. [PMID: 28442175 DOI: 10.1016/j.gerinurse.2017.03.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/16/2017] [Accepted: 03/20/2017] [Indexed: 10/19/2022]
Abstract
International guidelines promote active investigation and treatment of incontinence; however, these guidelines do not fully accommodate the psychosocial aspects associated with providing continence care i.e. the caregiving dynamics. The author developed a new framework that aims to support nurses and care workers in their efforts to identify and meet the continence care needs of individuals with complex health conditions who are dependent on another person for assistance to manage incontinence or to maintain continence. The framework is underpinned by two core concepts: 'dignity' and 'care', and is characterized by a focus on: empathic continence care; personhood in dementia; therapeutic communication; authentic partnership in continence care; acknowledging stigma, social taboos and courtesy stigma; and the need for a foundational continence assessment. This paper describes the Dignity in Continence Care Framework and suggests strategies for its use in the future education of nurses and care workers about continence care.
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Affiliation(s)
- Joan Ostaszkiewicz
- Deakin University, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Geelong, Australia.
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9
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Meyer P. [Algorithms and urinary incontinence in the elderly. Assessment, treatment, recommendations and levels of evidence. Review]. Prog Urol 2017; 27:111-145. [PMID: 28284822 DOI: 10.1016/j.purol.2017.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 01/08/2017] [Accepted: 01/24/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Search processing algorithms in a primary care setting, analyzing the specifics of care management for seniors suffering from urinary incontinence (UI), described the recommendations and levels of evidence of treatment. METHODS A literature review carried out via PubMed® and websites of scientific societies with search keywords classified according to an algorithm. RESULTS One hundred algorithms have been discovered in the field of evaluation and treatment of UI. Screening for UI risk factors began early on in the treatment of reversible or chronic comorbidities, avoiding iatrogenic. Specific clinical features (red flags) required specialized advice. Non-pharmacological conservative treatment should be offered first in line for seniors: behavioral therapy, changes in lifestyle, walk, treatment of constipation. For women, pelvic floor muscle training combined biofeedback and functional electrical stimulation. After failure and persistence of UI with urgency, the information of the risk of a possible urinary retention or cognitive impairments preceded the prescription of an anticholinergic and the measurement of post-voiding residue done by ultrasounds. Older age is not a cons-indication for surgery UI least invasive. The cough test and Bonney maneuver can confirm a masked stress urinary incontinence and/or an associated prolapse. Cases of failure of UI, doubtful diagnosis or programmed surgery required urodynamic assessment. CONCLUSION Algorithms and recommendations of UI should remain a valuable aid to the clinical assessment, diagnosis and treatment of UI in the elderly.
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Affiliation(s)
- P Meyer
- Service de réadaptation neurologique, centre de médecine physique et de réadaptation de L'ADAPT, 25, avenue de la Paix, 92320 Chatillon, France.
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Arnold EP, Milne DJ, English S. Conservative treatment for incontinence in women in rest home care in Christchurch: Outcomes and cost. Neurourol Urodyn 2015; 35:636-41. [PMID: 25854327 DOI: 10.1002/nau.22773] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 03/02/2015] [Indexed: 11/06/2022]
Abstract
AIMS To assess if conservative therapy can reduce urinary leakage and pad usage and improve quality of life in elderly incontinent women living in a rest home setting; and if so at what additional cost. METHODS Sixty-eight elderly women with urinary incontinence, and preserved cognitive ability, living in 26 rest homes were identified. Clinical evaluation, included bladder diary, pad weigh tests, pad usage, and quality of life and activities questionnaires (FIM: Functional Impairment Measure; EQ-5D: Euroquol 5 dimension score; ICIQ-SF: International Consultation on Incontinence-Short Form). A specialist Continence Advisor Nurse provided conservative treatment according to the needs of each participant. Outcomes were recorded after 12 weeks of treatment by repeating above evaluations, and the costs involved were measured. RESULTS Leakage was reduced by a mean of 60 ml per 24 hr, and four fewer pads were required per week. The ICIQ-SF improved significantly. The EQ-5D did not demonstrate significant improvement, so a cost-utility analysis was not possible. The mean cost of the Advisor's time and mileage in providing the 12 week course was $247.75 per participant. CONCLUSION Conservative therapies tailored to each individual, can improve the severity of leakage in the short term, even in this elderly group of women with preserved cognitive function, at modest additional cost. Measuring quality of life and the impact of incontinence, has challenges in this age group. Neurourol. Urodynam. 35:636-641, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
| | | | - Sharon English
- Department of Urology, Christchurch Hospital, Christchurch, New Zealand
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Orrell A, McKee K, Dahlberg L, Gilhooly M, Parker S. Improving continence services for older people from the service-providers' perspective: a qualitative interview study. BMJ Open 2013; 3:e002926. [PMID: 23901026 PMCID: PMC3731733 DOI: 10.1136/bmjopen-2013-002926] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 05/31/2013] [Accepted: 06/16/2013] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To examine in depth the views and experiences of continence service leads in England on key service and continence management characteristics in order to identify and to improve our understanding of barriers to a good-quality service and potential facilitators to develop and to improve services for older people with urinary incontinence (UI). DESIGN Qualitative semistructured interviews using a purposive sample recruited across 16 continence services. SETTING 3 acute and 13 primary care National Health Service Trusts in England. PARTICIPANTS 16 continence service leads in England actively treating and managing older people with UI. RESULTS In terms of barriers to a good-quality service, participants highlighted a failure on the part of commissioners, managers and other health professionals in recognising the problem of UI and in acknowledging the importance of continence for older people and prevalent negative attitudes towards continence and older people. Patient assessment and continence promotion regardless of age, rather than pad provision, were identified as important steps for a good-quality service for older people with UI. More rapid and appropriate patient referral pathways, investment in service capacity, for example, more trained staff and strengthened interservice collaborations and a higher profile within medical and nurse training were specified as being important facilitators for delivering an equitable and high-quality continence service. There is a need, however, to consider the accounts given by our participants as perhaps serving the interests of their professional group within the context of interprofessional work. CONCLUSIONS Our data point to important barriers and facilitators of a good-quality service for older people with UI, from the perspective of continence service leads. Further research should address the views of other stakeholders, and explore options for the empirical evaluation of the effectiveness of identified service facilitators.
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Affiliation(s)
- Alison Orrell
- School of Health and Related Research Sheffield, University of Sheffield, Sheffield, UK
| | - Kevin McKee
- School of Health and Social Studies, Dalarna University, Sweden and Aging Research Center, Karolinska Institutet & Stockholm University, Sweden
| | - Lena Dahlberg
- School of Health and Social Studies, Dalarna University, Sweden and Aging Research Center, Karolinska Institutet & Stockholm University, Sweden
| | - Mary Gilhooly
- School of Health Science and Social Care, Brunel University, Uxbridge, UK
| | - Stuart Parker
- University of Sheffield, Sheffield Institute for Studies on Ageing, Samuel Fox House Northern General Hospital, Sheffield, UK
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Bettez M, Tu LM, Carlson K, Corcos J, Gajewski J, Jolivet M, Bailly G. 2012 update: guidelines for adult urinary incontinence collaborative consensus document for the canadian urological association. Can Urol Assoc J 2012; 6:354-63. [PMID: 23093627 PMCID: PMC3478335 DOI: 10.5489/cuaj.12248] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Mathieu Bettez
- Department of Surgery, Division of Urology, Université de Sherbrooke, Sherbrooke, QC
| | - Le Mai Tu
- Department of Surgery, Division of Urology, Université de Sherbrooke, Sherbrooke, QC
| | - Kevin Carlson
- Department of Surgery, Division of Urology, University of Calgary, Calgary, AB
| | - Jacques Corcos
- Department of Surgery, Division of Urology, McGill University, Montreal, QC
| | - Jerzy Gajewski
- Department of Urology, Dalhousie University, Halifax, NS
| | - Martine Jolivet
- Department of Surgery, Division of Urology, Université de Montréal, Montreal, QC
| | - Greg Bailly
- Department of Urology, Dalhousie University, Halifax, NS
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Fader MJ, Cottenden AM, Gage HM, Williams P, Getliffe K, Clarke-O'Neill S, Jamieson KM, Green NJ. Individual budgets for people with incontinence: results from a 'shopping' experiment within the British National Health Service. Health Expect 2012; 17:186-96. [PMID: 22390825 DOI: 10.1111/j.1369-7625.2011.00750.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND CONTEXT Most people with urinary incontinence are given limited choice when provided with absorbent products through the British National Health Service (NHS), even though the available range is large. OBJECTIVE To investigate users' preferences for four disposable designs (inserts, all-in-ones, belted/T-shaped and pull-ups) and towelling washable/reusable products, day and night. DESIGN Shopping experiment. SETTING AND PARTICIPANTS Community-dwelling women and men in England with moderate-to-heavy urinary incontinence recruited to a larger trial. INTERVENTION Participants tested each design and selected products they would prefer with a range of different budgets. MAIN OUTCOME MEASURES Design preferences (rankings); 'purchasing' decisions from designated budgets. Results Eighty-five participants (49 men) tested products, 75 completed the shopping experiment. Inserts, most frequently supplied by the NHS, were ranked second to pull-ups by women and lowest by men. When faced with budget constraints, up to 40% of participants opted to 'mix-and-match' designs. Over 15 different combinations of products were selected by participants in the shopping experiment. Most (91%) stated a willingness to 'top-up' assigned budgets from income to secure preferred designs. DISCUSSION Participants displayed diverse preferences. Enabling user choice of absorbent product design through individual budgets could improve satisfaction of consumers and efficiency of allocation of limited NHS resources. CONCLUSION Recent policy for the NHS seeks to provide consumers with more control in their care. Extension of the concept of individual budgets to continence supplies could be feasible and beneficial for patients and provide better value-for-money within the NHS. Further research is warranted.
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Affiliation(s)
- Mandy J Fader
- Professor, Faculty of Health Sciences, University of Southampton, SouthamptonProfessor, Department of Medical Physics, University College London, Archway Campus, Highgate Hill, LondonReader, Department of Economics, University of Surrey, Guildford, UKStatistical Consultant, Department of Mathematics, University of Surrey, Guildford, UKProfessor (Retired), Faculty of Health Sciences, University of Southampton, SouthamptonResearch Fellow, Department of Medical Physics, University College London, Archway Campus, Highgate Hill, London, UK
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Yamaguchi O. Editorial: Issues Surrounding the Symptom of Urgency. Low Urin Tract Symptoms 2012; 4:1-2. [DOI: 10.1111/j.1757-5672.2011.00128.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Chartier-Kastler E, Ballanger P, Petit J, Fourmarier M, Bart S, Ragni-Ghazarossian E, Ruffion A, Le Normand L, Costa P. Randomized, crossover study evaluating patient preference and the impact on quality of life of urisheaths vs absorbent products in incontinent men. BJU Int 2010; 108:241-7. [DOI: 10.1111/j.1464-410x.2010.09736.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wang K, Palmer MH. Women’s toileting behaviour related to urinary elimination: concept analysis. J Adv Nurs 2010; 66:1874-84. [DOI: 10.1111/j.1365-2648.2010.05341.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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DuBeau CE, Kuchel GA, Johnson II T, Palmer MH, Wagg A. Incontinence in the frail elderly: Report from the 4th international consultation on incontinence. Neurourol Urodyn 2010; 29:165-78. [DOI: 10.1002/nau.20842] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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