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BMC Health Services Research
Published in: BMC Health Services Research 1/2008

Open Access 01-12-2008 | Study protocol

The effects of involving a nurse practitioner in primary care for adult patients with urinary incontinence: The PromoCon study (Promoting Continence)

Authors: Pytha Albers-Heitner, Bary Berghmans, Manuela Joore, Toine Lagro-Janssen, Johan Severens, Fred Nieman, Ron Winkens

Published in: BMC Health Services Research | Issue 1/2008

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Abstract

Background

Urinary incontinence affects approximately 5% (800.000) of the Dutch population. Guidelines recommend pelvic floor muscle/bladder training for most patients. Unfortunately, general practitioners use this training only incidentally, but prescribe incontinence pads. Over 50% of patients get such pads, costing €160 million each year. Due to ageing of the population a further increase of expenses is expected. Several national reports recommend to involve nurse specialists to support general practitioners and improve patient care. The main objective of our study is to investigate the effectiveness and cost-effectiveness of involving nurse specialists in primary care for urinary incontinence. This paper describes the study protocol.

Methods/Design

In a pragmatic prospective multi centre two-armed randomized controlled trial in the Netherlands the availability and involvement for the general practitioners of a nurse specialist will be compared with usual care. All consecutive patients consulting their general practitioner within 1 year for urinary incontinence and patients already diagnosed with urinary incontinence are eligible. Included patients will be followed for 12 months.
Primary outcome is severity of urinary incontinence (measured with the International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI SF)). Based on ICIQ-UI SF outcome data the number of patients needed to include is 350. For the economic evaluation quality of life and costs will be measured alongside the clinical trial. For the longer term extrapolation of the economic evaluation a Markov modelling approach will be used.

Discussion/Conclusion

This is, to our knowledge, the first trial on care for patients with urinary incontinence in primary care that includes a full economic evaluation and cost-effectiveness modelling exercise from the societal perspective. If this intervention proves to be effective and cost-effective, implementation of this intervention is considered and anticipated.

Trial registration

Current Controlled Trials ISRCTN62722772
Appendix
Available only for authorised users
Literature
1.
GIP/Health Insurance Board: Total cost 2002-2006. 2007
2.
Teunissen TAM, Bosch van den WJHM, Hoogen van den HJM, Lagro-Janssen ALM: Prevalence of urinary, fecal and double incontinence in the elderly living at home. Int Urogynecol J. 2004, 15 (1): 10-13. 10.1007/s00192-003-1106-8.CrossRef
3.
Abrams P, Cardozo L, Khoury S, Wein A: Incontinence. 3rd International Consultation on Incontinence. 2005, Monaco, Health Publication Ltd, 1&2.
4.
Norton P, Brubaker L: Urinary incontinence in women. Lancet. 2006, 367 (9504): 57-67. 10.1016/S0140-6736(06)67925-7.CrossRefPubMed
5.
Health Council of the Netherlands: Urinary Incontinence. 2001, The Hague, Health Council of the Netherlands
6.
Health Insurance Board (CVZ): Urine incontinentie (Urinary Incontinence). 2003, Amstelveen, Health Insurance Board (CVZ)
7.
Melville JL, Katon W, Delaney K, Newton K: Urinary Incontinence in US Women: A Population-Based Study. Arch Intern Med. 2005, 165 (5): 537-542. 10.1001/archinte.165.5.537.CrossRefPubMed
8.
Newman DK, Denis L, Gruenwald I, Ee CH, Millard R, Roberts R, Sampselle C, Williams K: Promotion, education and organisation for continence care. Incontinence 2nd International Consultation on Incontinence. Edited by: Abrams P, et al. 2002, Plymouth, Health Publication Ltd
9.
Lagro-Janssen ALM, Teunissen D, Breedveldt-Boer HP, Dongen van JJAM, Lemain TJJ, Steeneken F, Dijkstra RH, Wiersma TJ: NHG-Standaard Incontinentie voor Urine M46 Eerste herziening (Dutch College Guideline on Urinary Incontinence. First revision). Huisarts Wet. 2006, Nederlandse Huisartsen Genootschap, 49 (2): 501-510.
10.
Kirby M: Managing stress urinary incontinence - a primary care issue. Int J Clin Pract. 2006, 60 (2): 184-189. 10.1111/j.1742-1241.2006.00715.x.CrossRefPubMed
11.
Albers-Heitner P, Berghmans B, Nieman F, Lagro-Janssen T, Winkens R: Adherence to professional guidelines for patients with urinary incontinence by general practitioners: a cross-sectional study. J Eval Clin Pract.
12.
Albers-Heitner P, Berghmans B, Nieman F, Lagro-Janssen T, Winkens R: How do patients with urinary incontinence perceive care given by their general practitioner? A cross-sectional study. Int J Clin Pract. 2008, 62 (3): 508-515. 10.1111/j.1742-1241.2007.01693.x.CrossRefPubMed
13.
Westert GP, Schellevis FG, de Bakker DH, Groenewegen PP, Bensing JM, Zee J: Monitoring health inequalities through general practice: the Second Dutch National Survey of General Practice. Eur J Public Health. 2005, 15 (1): 59-65. 10.1093/eurpub/cki116.CrossRefPubMed
14.
Faber E, Custers JWH, Berghmans LCM, Dongen van JJAM, Groeningen van COM, Grupping-Morel MHM, Hogen Esch FAH, Lagro-Janssen ALM, Pinxteren van B, Verstappen WHIM: Landelijke Eerstelijns Samenwerkings Afspraak Incontinentie voor Urine (National First Line Multidisciplinary Agreement) 'LESA'. Huisarts Wet. 2007, 50 (5): S9-S12.
15.
Grol R, Buchan H: Clinical guidelines: what can we do to increase their use?. Med J Aust. 2006, 185 (6): 301-302.PubMed
16.
Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PAC, Rubin HR: Why Don't Physicians Follow Clinical Practice Guidelines?: A Framework for Improvement. JAMA. 1999, 282 (15): 1458-1465. 10.1001/jama.282.15.1458.CrossRefPubMed
17.
Vrijhoef HJ: Is it justifiable to treat chronic patients by nurse specialists?. PhD Thesis. 2002, Department of General Practice, Maastricht, The Netherlands, Maastricht University
18.
Berg van den M, Bakker de D: Meta-analyse introductie praktijkondersteuning op HBO-niveau in de huisartspraktijk in Nederland. 2003, NIVEL
19.
Borrie MJ, Bawden M, Speechley M, et al: A nurse/physician continence clinic triage approach for urinary incontinence: a 25-week randomised trial. Neurourol Urodyn. 1992, 11: 364-365.
20.
21.
Berghmans LCM, Hendriks HJM, Bø K, Hay-Smith EJ, Bie de RA, Waalwijk van Doorn van ESC: Conservative treatment of stress urinary incontinence in women: a systematic review of randomized clinical trials. Br J Urol. 1998, 82: 181-191.CrossRefPubMed
22.
Williams KS, Assassa RP, Smith NK, Jagger C, Perry S, Shaw C, Dallosso H, McGrother C, Clarke M, Brittain KR, Castleden CM, Mayne C: Development, implementation and evaluation of a new nurse-led continence service: a pilot-study. J Clin Nursing. 2000, 9: 566-573. 10.1046/j.1365-2702.2000.00386.x.CrossRef
23.
Williams KS, Assassa RP, Cooper NJ, Turner DA, Shaw C, Abrams KR, Mayne C, Jagger C, Matthews R, Clarke M, McGrother CW, The Leicestershire MRC Incontinence Study Team: Clinical and cost-effectiveness of a new nurse-led continence service: a randomised controlled trial. Br J Gen Pract. 2005, 55 (518): 696-703.PubMedPubMedCentral
24.
Abrams P, Cardozo L, Fall M, Griffits D, Rosier P, Ulmsten U, Kerrebroeck van P, Victor A, Wein A: The standardisation of Terminology of Lower Urinary Tract function: Report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002, 21: 167-178. 10.1002/nau.10052.CrossRefPubMed
25.
Brown JS, Bradley CS, Subak LL, Richter HE, Kraus SR, Brubaker L: Diagnostic aspects of Incontinence Study (DAISy) Research Group. The sensitivity and specificity of a simple test to distinguish between urge and stress urinary incontinence. Ann Intern Med. 2006, 144: 715-723.CrossRefPubMedPubMedCentral
26.
NVFB: Functieprofiel Bekkenfysiotherapeut. 2003, Dutch Association for Physical Therapy for Pelvic Floor Disorders and Pre- and Postnatal Healthcare (NVFB), 56.
27.
VNIV: Incontinentieverpleegkundige. Beroepsdeelprofiel. 2004, Utrecht , Vereniging Nederlandse Incontinentie Verpleegkundigen (VNIV), 28.
28.
Verhulst FJCM, Burgt van der MCA, Lindner K: Concretisering van patiëntenvoorlichting in het fysiotherapeutisch handelen. Ned T Fysio. 1994, 1: 10-17.
29.
Damoiseaux V, Molen van der HT, Kok GJ: Gezondheidsvoorlichting en gedragsverandering. 1993, Assen , Van Gorcum & Comp B.V.
30.
Messelink EJ, Bemelmans BL, Groot JA, Gisolf KW, Vervest HA, Berghmans LC, Everaerd WT, Kil PJ, Wiersma T: Urge en urge-incontinentie. 2002, Utrecht, Nederlandse Vereniging voor Urologie (NVU)
31.
Venema PL, Geelen van JM, Kil PJ, Capelle van JW, Tjon Pian Gi NP, Ridder de D, Wiersma T: Richtlijn Stressincontinentie bij de vrouw (Guideline Stress Incontinence in women). 2003, Utrecht, Nederlandse Vereniging voor Urologie (NVU)
32.
Donovan J, Badia X, Corcos J, Gotoh M, Kelleher C, Naughton MJ, Shaw C: Symptom and quality of life assessment, July 1-3, 2001. Incontinence: Proceedings of the Second International Consultation on Incontinence. Edited by: Cardozo L, Khoury S, & Wein A. 2002, Plymouth, Health Publication Ltd, 267-316. 2nd
33.
Avery K, Donovan J, Peters T, Shaw C, Gotoh M, Abrams P: ICI-Q: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn. 2004, 23 (4): 322-330. 10.1002/nau.20041.CrossRefPubMed
34.
Euroqol Group: Euroqol - a new facility for the measurement of health related quality of life. Health Policy. 1990, 16: 199-208. 10.1016/0168-8510(90)90421-9.CrossRef
35.
Hessel FP, Wittmann M, Petro W, Wasem J: Methoden zur kostenverfassung im Rahmen der okonomischen evaluation einer rehabilitationsmassnahme bei chronischen atemwegserkrankungen. Pneumologie. 2000, 54: 289-295. 10.1055/s-2000-4455.CrossRefPubMed
36.
Koopmanschap MA, Meerding WJ, Evers S, Severens J, Burdorf A, Brouwer W: Handleiding voor het gebruik van PRODISQ versie 2.1 (PROductivity and DISease Questionnaire). Een modulaire vragenlijst over de relatie tussen ziekte en productiviteitskosten. Toepasbaar bij economische evaluaties van gezondheidszorgprogramma’s voor patiënten en werknemers. 2004, Rotterdam/Maastricht
37.
Brink van den M, Hout van den WB, Stiggelbout AM, Velde van de CJH, Kievit J: Cost measurement in economic evaluations of health care. Whom to ask?. Med Care. 2004, 42 (8): 740-746. 10.1097/01.mlr.0000132351.78009.a1.CrossRef
38.
Uebersax JS, Wyman JF, Shumaker SA, McClish DK, Fantl JA, and the Continence Program for Women Research Group : Short forms to assess life quality and symptom distress for urinary incontinence in women: the Incontinence Impact Questionnaire and the urogenital Distress Inventory. Neurourol Urodyn. 1995, 14: 131-139. 10.1002/nau.1930140206.CrossRefPubMed
39.
Vaart van der CH, Leeuw de JRJ, Roovers JPWR, Heintz APM: De invloed van urine-incontinentie op de kwaliteit van leven bij thuiswonende Nederlandse vrouwen van 45-70 jaar. Ned Tijdschr Geneeskd. 2000, 144 (19): 894-897.
40.
Blaivas JG, Appell RA, Fantl JA, Leach G, McGuire EJ, Resnick NM, Raz S, Wein AJ: Standards of efficacy for evaluation of treatment outcomes in urinary incontinence: recommendations of the Urodynamic Society. Neurourol Urodyn. 1997, 16 (3): 145-147. 10.1002/(SICI)1520-6777(1997)16:3<145::AID-NAU2>3.0.CO;2-E.CrossRefPubMed
41.
Blaivas JG, Appell RA, Fantl JA, Leach G, McGuire EJ, Resnick NM, Raz S, Wein AJ: Definition and classification of urinary incontinence: recommendations of the Urodynamic Society. Neurourol Urodyn. 1997, 16 (3): 149-151. 10.1002/(SICI)1520-6777(1997)16:3<149::AID-NAU3>3.0.CO;2-E.CrossRefPubMed
42.
Mattiasson A, Djurhus JC, Fonda D, Lose G, Nordling J, Stöhrer M: Standardization of outcome studies in patiënts with lower urinary tract dysfunction: a report on general principles from the standardization committee of the International Continence Society. Neurourol Urodyn. 1998, 17: 249-253. 10.1002/(SICI)1520-6777(1998)17:3<249::AID-NAU9>3.0.CO;2-D.CrossRefPubMed
43.
Blaivas JG: Outcome measures for urinary incontinence. Urology. 1998, 51 (Suppl 2A): 11-19. 10.1016/S0090-4295(98)90002-4.CrossRefPubMed
44.
Abrams P, Cardozo L, Khoury S, Wein A: Incontinence Proceedings 2nd International Consultation on Incontinence - July 1, 2001- July 3, Paris. 2002, Health Publication Ltd, 976.
45.
Dolan P: Modeling Valuations for EuroQol Health States. Med Care. 1997, 35 (11): 1095-1108. 10.1097/00005650-199711000-00002.CrossRefPubMed
46.
Oostenbrink JB, Bouwmans CM, Koopmanschap MA, Rutten FFH: Manual for Cost Analysis. 2004, Amstelveen , College voor Zorgverzekeringen. (In Dutch)
47.
Laurant M, Reeves D, Hermens R, Braspenning J, Grol R, Sibbald B: Substitution of doctors by nurses in primary care. 2004, Cochrane Database of Systematic Reviews
Metadata
Title
The effects of involving a nurse practitioner in primary care for adult patients with urinary incontinence: The PromoCon study (Promoting Continence)
Authors
Pytha Albers-Heitner
Bary Berghmans
Manuela Joore
Toine Lagro-Janssen
Johan Severens
Fred Nieman
Ron Winkens
Publication date
01-12-2008
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2008
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-8-84

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