Improving continence services for older people from the service-providers’ perspective: a qualitative interview study

Abstract

ObjectiveTo 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).DesignQualitative semistructured interviews using a purposive sample recruited across 16 continence services.Setting3 acute and 13 primary care National Health Service Trusts in England.Participants16 continence service leads in England actively treating and managing older people with UI.ResultsIn 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.ConclusionsOur 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.

Understanding help-seeking in older people with urinary incontinence: an interview study

“…Other research has found a need for improvements in service capacity, for example, regarding staff training and inter‐service collaboration (Orrell et al . ). Importantly, the national audit did not capture the views of service users on why they sought help.…”

“…A UK national audit of continence care for older people, which sampled acute and rehabilitation hospitals, found poorly integrated continence services and an inconsistent screening for UI or adequate assessment by service providers (Wagg et al 2010). Other research has found a need for improvements in service capacity, for example, regarding staff training and inter-service collaboration (Orrell et al 2013). Importantly, the national audit did not capture the views of service users on why they sought help.…”

Registered nurse’s experiences of continence care for older people: A qualitative descriptive study

“…Attitudes towards UI, both in general (i.e. in society) and within the healthcare setting, have been found to be partially negative (Orrell, McKee, Dahlberg, Gilhooly, & Parker, ). The routine management of incontinence (i.e.…”

Determinants of referral of women with urinary incontinence to specialist services: a national cohort study using primary care data from the UK

“…Also, the delivery and organisation of continence services in primary and secondary care should be scrutinised [ 28 ]. Clear referral pathways and investment in capacity, for example, through the provision of more trained staff and a higher profile for continence care within medical training, have been identified as possible facilitators for the delivery of high-quality and equitable continence services.…”