MADRID, SPAIN (UroToday.com) - The Global Forum on Incontinence (GFI), sponsored by SCA, was held in Madrid on April 8-9, 2014. The meeting was entitled “Better Care, Better health -- Towards a Framework for Better Continence Solutions,” and the speakers were multidisciplinary professionals who covered a wide range of topics with a focus on the elderly and care models.
The target of this 5th GFI was policymakers, those who make decisions about the provision of services for persons with incontinence. At the meeting, a landmark document on “Summary of Optimum Continence Service Specification” was released. This was the product of a panel of experts that included, Professor Adrian Wagg, Dr. Paul von Hotten, researcher Kai Leichsenring, and myself, Diane Newman. The project was sponsored by SCA Global. KPMG Healthcare and Life Sciences Strategy Group assisted in the development and research of this report and Professor Hilary Thomas presented the essence of the report at the GFI meeting. The expert panel identified four different profiles of patients requiring care for incontinence:
- stress and urgency,
- fecal incontinence,
- neurological, and
- elderly/cognitively impaired.
These profiles were the basis for determining service specifications for continence care in four distinct health care systems of India, The Netherlands, United Kingdom, and the USA. Based on the panel’s findings, a health economic evaluation was conducted using as a patient model the elderly/cognitively impaired person with incontinence who would be treated by the Dutch health care system. The aim of the study was to determine costs and effects of the optimum continence service specification compared with current care in The Netherlands. Professor Al Maiween, Erasmus University, conducted the economic analysis and presented the findings at this meeting. The study outcome was that continence nurse practitioners (NP) practicing in primary care practices could improve levels of incontinence detection and screening, improve quality of life, and reduce societal costs. This model of continence care makes sense in many countries, but especially in the United States where there are 189 000 NPs, and the majority practice in primary care in collaboration with physicians. Professor Maiween’s data indicate that utilizing these NPs could be cost-effective and improve continence care. According to surveys conducted over the last 2 decades, less than 50% of persons with incontinence report their symptoms to a health care provider. If the NP model of care could be placed in practice, this would be a game changer from current continence care.
Other Lectures of Interest at the Meeting
Joachim Bacher, TNS Infratest, Germany, presented the results of a survey about incontinence knowledge and awareness among the general public, conducted in 4 countries: UK (n=1215), Germany (n=1228), Sweden (n=1201), and India. All were online surveys, except for India where interviews were conducted. Results were very similar amongst the countries, with 80 to 90% noting that UI affects daily living and the individual’s self-perception. Although survey results indicated that most respondents were aware of UI, less than 25% had knowledge and understanding about the condition. Prof. Bacher compared respondents’ awareness and knowledge about UI to that of diabetes, both chronic illnesses, but UI was less understood. In testing knowledge, he asked about the main causes of UI. Respondents from the UK, Germany and Sweden answered that UI was: part of old age, caused by weakening of the pelvic floor, pregnancy, childbirth, bladder inflammation, and injury or surgery of the pelvic floor. India identified two known risk factors: diabetes and being overweight, as well as being related to genetics/family history and old age.
Respondents from India and Germany felt that UI was a serious problem (72% and 76 % respectively) while Sweden at 34% and UK at 40%, rated the seriousness much lower. Respondents identified the main consequences to patients with UI as shame, embarrassment, depression, loss of dignity, impact on sexual life, social isolation, sleeplessness, and costs / economic impact. This is in contrast to the consequences identified by caregivers, and those consequences included odor, costs/economics, and feelings of uneasiness. The survey asked respondents if they felt UI was preventable, curable, or manageable. Not surprisingly, most respondents, from all 4 countries, felt that UI was not preventable and not curable. However, responses from India differed as majority of respondents felt that UI was preventable but not manageable.
When respondents who had experienced incontinence were asked if they had seen a health care professional for a diagnosis, results varied with 50%, 67%, and 49% from the UK, Germany, and Sweden, respectively, indicating they had. The majority of those respondents received an explanation as to why they were leaking urine, but less than 50% received information about treatment options. Respondents from these same countries felt that quality of care was not very good, but India was the opposite. Prof. Bacher’s conclusions were that awareness of UI among the general population is high, but the knowledge level is low. Large proportions of people are not diagnosed and there is a low awareness among the public as to the possibility of prevention and and of management options. Across all countries and respondents, services for incontinence are insufficient. Results of this survey are not surprising and highlight the need for service delivery amongst all health care entities.
Prof. Karin Coyne, Evidera, USA, spoke on the impact of incontinence with focus on emotional well-being and mental health. Social taboos surround the subject of incontinence, and this increases difficulties for women who feel that UI is a normal part of aging and, thus, do not seek treatment. The impact of UI is multifaceted as it causes increased isolation, depression, it decreases and limits physical activity, decreases social support, decreases social activity, decreases self-esteem, and causes embarrassment. She presented the results of her extensive research on the impact of UI on sufferers. She provided quotes from patients describing how they feel a loss of self-esteem, loss of personal coping, and embarrassment. Prof. Coyne noted the impact is incremental and poses a greater negative impact on health-related quality of life than other chronic conditions. She noted that UI affects mental health in both men and women, especially in women with related depression. Women with UI have less sexual enjoyment, especially if they experience urine leakage with intercourse or urgency during intimacy. What is not understood is the longitudinal impact of UI.
Reported for UroToday.com by Diane K. Newman, DNP, FAAN, BCB
