The costs of urinary incontinence

Bladder dysfunction and quality of life for people with multiple sclerosis

PURPOSE

Bladder dysfunction affects 75% of people with multiple sclerosis (MS). People with MS are reluctant to seek treatment for this distressing symptom. This is the first-known study to explore in depth how bladder dysfunction interferes with quality of life for people with MS.

METHODS

Nineteen individual semi-structured interviews were conducted (M = 8, F = 11). Participants had a definite diagnosis of MS, aged between 37 and 64 years and had at least one bladder dysfunction symptom. The audio-recorded interviews lasted up to 90 min and were transcribed verbatim.

RESULTS

Thematic analysis within NVivo10 yielded two key themes: (1) Disruptions and loss and (2) ways of knowing. "Disruptions and Loss" explores how bladder dysfunction interrupted daily living activities and how this contributed to experiencing loss. "Ways of knowing" portrays the types of knowledge that existed around bladder dysfunction. Participants described using their experiential knowledge to self-manage bladder symptoms without advice from healthcare providers.

CONCLUSIONS

Bladder dysfunction imposes major disruptions on daily life. People with MS attempt to self-manage their bladder symptoms, despite current barriers to navigating existing healthcare infrastructure. Understanding these barriers and the individual strategies employed by people with MS are the first steps in facilitating independent management of bladder dysfunction. Implications for Rehabilitation Each individual's experience of bladder dysfunction is unique. Healthcare professionals must be prepared to discuss all disruptions and losses associated with bladder dysfunction for people with MS. People with MS have a vast range of knowledge in relation to their own bladder symptoms and healthcare professionals need to explore their existing self-management strategies during assessment. People with MS and healthcare professionals need to be educated on the wider health implications relating to bladder dysfunction.

Economic impact of tension-free vaginal tape surgery for urinary incontinence in an ambulatory regimen compared with hospital admission

OBJECTIVES

To determine the cost per patient of a tension-free vaginal tape procedure involving major ambulatory surgery (MAS) compared with inpatient surgery in 2002 and 2003, and to analyse the medical care given following each procedure in a public hospital in Spain.

MATERIAL AND METHODS

The method used was activity-based costing, which involves designing a protocol of processes of caring for the patient with the help of professionals and subsequently calculating the cost of each process; this system was applied retrospectively to patients cared for in 2002 and 2003. In addition, the clinical histories of these patients were reviewed in order to evaluate complementary care given by the emergency service and admissions to hospital immediately following surgery. The relation between these events and each sample group was analysed by means of a non-parametric test and CIs for a 95% level of significance were obtained in order to make the calculations more robust.

RESULTS

The mean cost for the patients in the ambulatory group was 42.43% lower than that for the hospitalized patients. Whereas 5.5% of the ambulatory patients subsequently required admission and a further 7.3% required complementary medical care, 19.2% of the patients who had been hospitalized for the surgery required complementary medical care and 1.4% were readmitted after intervention. In spite of these results, there was no dependence between these variables according to the chi(2) test.

CONCLUSION

MAS produced better results in terms of minimizing costs; under our conditions it was less costly but was of equal efficacy to the surgical intervention.

Multiple sclerosis and continence issues: an exploratory study

The study described in this article aimed to identify issues relating to incontinence and assess the impact of referral to a continence adviser on the lives of people with multiple sclerosis (MS). The study design used an in-depth, two-phase anonymous mail survey within a general community as nominated by the participants. Fifty-six people participated in phase 1 and eleven people completed phase 2. The results indicated that incontinence is a problem for the vast majority of participants--people with MS. One-third of the eligible participants took up the option of a consultation, assessment and treatment from a continence nurse. Reasons for not taking up the visit from the continence nurse included 'managing OK', 'didn't think it would help', 'embarrassed' and 'too busy'. Increasing awareness of urinary incontinence in the community is important and education needs to focus on at-risk groups in presenting the range of options available to assist people experiencing incontinence.

Atención farmacéutica en un centro socio-sanitario

OBJECTIVE

To reflect the activity of the pharmacy department within the nursing home s multidisciplinary team, and to assess care improvements received by residents, including a better use of drugs.

METHOD

In addition to pharmacotherapeutical guidelines and a standardized work procedure listing generic and therapeutic replacements to be implemented, selected procedures were specified in order to ensure a rational use of drugs and to increase the quality of care received by residents in our center. Such procedures will be performed by the center s multidisciplinary team and will focus on caring the caring for so-called geriatric syndromes.

RESULTS

After an assessment of treatments for 125 patients and a 3-month follow-up, 10 interventions per patient were performed, out of which 4.74 were pharmacist interventions and 5.26 were to increase quality of care.

CONCLUSIONS

The presence of the pharmacy department within the multidisciplinary team ensures a better use of drugs and a safe delivery system. Its activity contributes to improve quality of care, most notably procedures regarding nutritional status, and the prevention and treatment of pressure ulcers.

Urinary incontinence in subacute care--a retrospective analysis of clinical outcomes and costs

OBJECTIVE

To investigate the effect of incontinence on clinical outcomes and costs for patients in subacute care.

DESIGN

Retrospective analysis of data collected over a 3-month period in 1996.

SETTING

54 medical facilities in Australia and New Zealand providing subacute care in an inpatient setting.

PATIENTS

6773 episodes of care provided to 6455 rehabilitation and geriatric evaluation and management patients.

MAIN OUTCOME MEASURES

Urinary continence status, treatment outcomes, length of stay, discharge destination, and nursing and allied healthcare costs.

RESULTS

Discharge destination differed between incontinent and continent patients (57% compared with 82%, respectively, discharged home, and 29% compared with 12%, respectively, discharged to a nursing home or to further care). There was a difference in cost between patients who were continent and those who were incontinent throughout their episode of care (rehabilitation: $185.60 [95% CI, $181-$190] per day for incontinent and $156.82 [95% CI, $153-$160] for continent patients; and geriatric evaluation and management: $164.62 [95% CI, $157-$172] for incontinent and $121.40 [95% CI, $114-$129] for continent patients). However, multilevel analyses showed that, after allowing for age and level of functional independence, the contribution of continence status to the cost of care depended on the functional independence of the patient (cognitive function for orthopaedic patients [P < 0.01] and motor function for stroke patients [P = 0.04]).

CONCLUSION

The relationship between continence status and cost of care is complex. However, the cost differences found in our study need to be considered in payment systems, allocation of staff levels on wards and in development of casemix classifications.