Overactive Bladder and Continence Guidelines: implementation, inaction or frustration?

Abstract

Guidelines for the management of continence and overactive bladder are generally available across Europe. For a majority of countries, these have been adopted by professional societies in either urology or gynaecology for local use. There has, however, been little monitoring of formal implementation of these guidelines and seldom any attempt to audit their operation. The state of continence care therefore remains largely unknown. This article reviews current guidelines and their status across Europe and examines what might be relevant from other disease areas to promote successful implementation.

Effectiveness of involving a nurse specialist for patients with urinary incontinence in primary care: results of a pragmatic multicentre randomised controlled trial

“…Involving nurse specialists in care for UI patients supplementary to general practitioners can improve severity and impact of UI: involving nurse specialists in UI primary care reduced severity and impact of UI after 3 months of intervention, after correction for effect modifiers; this is also the case in specific situations such as anxiety/depression. sons, such as lack of knowledge, other clinical priorities, lack of time and lack of targeted implementation strategies to adopt and practice guideline recommendations (4,5,(8)(9)(10)(11)(12). Therefore, employing nurse specialists may offer a solution to improve the quality of care in general practice provided to UI patients.…”

“…So far, UI has not been receiving much attention in general practice, despite the large number of patients who suffer from it. Probably, there are several reasons, such as lack of knowledge, other clinical priorities, lack of time and lack of targeted implementation strategies to adopt and practice guideline recommendations (4,5,8–12). Therefore, employing nurse specialists may offer a solution to improve the quality of care in general practice provided to UI patients.…”

Improving nurse engagement in continence care

“…[63][64][65][66] Thus, there remains a problem, one of implementation, a well-recognized phenomenon in guideline generation. 67 There are highly variable efforts put into dissemination of guidelines and their implementation. The National Institute for Health and Care Excellence, in England and Wales, is a notable exception, with a plethora of online materials developed to support this, including advice for providers and payers of health care services and patients themselves.…”

Nurses deliver on urinary continence in primary care!

“…These were incorporated the following year in to an NHS Framework for Older People; this mandated the establishment of integrated services by 2004. However, it has become evident that despite the availability of appropriate guidelines, implementation of these across developing countries has been poor (14). A National Audit of Continence Care published in August 2010 reported that only four services in the country met these standards (15).…”

“…Effective and early treatment will improve health trajectories for patients and head off significant expense to healthcare systems. Drivers for implementation of this valuable approach have been outlined by others previously in this journal (14). There is a clear requirement to improve practice in this area.…”