Developing an Internationally-Applicable Service Specification for Continence Care: Systematic Review, Evidence Synthesis and Expert Consensus

Abstract

BackgroundGlobal demographic trends suggest that the incidence of both urinary and faecal incontinence will rise in the coming years, bringing significant health and economic implications for both patients and payers. There is limited organisational evidence to guide payers and providers about service configuration which will deliver efficient guideline-compliant, high-quality patient care.ObjectivesTo create, using evidence from a systematic review, qualitative data and expert consensus an internationally applicable service specification for continence care.MethodEvidence was obtained from a systematic and grey literature review of published randomised controlled trials and quasi-experimental studies reporting efficacy of continence service design at the level of the community dwelling patient with either bladder or bowel incontinence, governmental reports and policy frameworks supplemented by data from 47 semi-structured interviews with clinicians, patients, patient-representatives and policy experts from four geographies broadly representative of different healthcare systems.ResultsA number of themes related to current and potential future organisation of continence care were identified from the data. A modular service specification with eight core components was created including case detection, initial assessment and treatment, case co-ordination, caregiver support, community-based support, specialist assessment and treatment, use of containment products, and use of technology. Within this framework important key recommendations are: ensure robust referral pathways, shift assessment for case coordination to nurses specializing in continence care, promote self-management and technology, use comprehensive assessment tools and service performance targets based on outcome and operational measures.ConclusionsThis study has defined practice gaps in the provision of continence services and described eight core components of a service specification for incontinence that commissioners and payers of health and social care could consider using to provide high-quality continence care. A shift towards a community-delivered, nurse-led model appears to be associated with clinical and cost-effective care for people with bladder and bowel incontinence.

Can incontinence be cured? A systematic review of cure rates

“…It has previously been suggested that the provision of continence management be considered for four patient profiles, namely those with (1) UI, (2) FI, (3) disabled/neurological illnesses, or (4) the elderly/cognitively impaired [20]. …”

Systematic review of the prevalence of faecal incontinence

“…Faecal incontinence (FI) is an under‐reported but common problem, which is associated with substantial economic burden. Accurate assessment of the prevalence of FI has important implications for the development of treatments and services. However, estimation of the severity of the problem in the adult community population has been difficult owing to the frequent reluctance of individuals to volunteer their FI symptoms, despite these having a devastating impact on their quality of life.…”

Objectively improving appropriateness of absorbent products provision to patients with urinary incontinence: The DIAPPER study

“…Appropriate continence products provision, together with patients/carers involvement and education in product selection and use, were found to be key for the products effectiveness as for any assistive device intended to address a disability or impairment . In this contest, the main finding of the present study was the observation that most of patients provided with continence products was not using the appropriate product.…”