Some issues in the clinical, social and economic evaluation of new nursing services

Abstract

This paper describes a study of a new nursing post, that of the adviser on incontinence. Some of the difficulties encountered in the study were the composition of a study and control group and evaluation of change in urinary incontinence. Retrospective checks on the two groups showed that the items in which they differed did not have any relationship with changes in incontinence or its management. The findings were unable to support the Regional Health Authority's hope that hospital admissions would be reduced or the more general belief that overall resource use would decline. In addition to improvements in incontinence half the subjects identified other benefits such as increased understanding of the problem and the opportunity to discuss it with someone with a knowledge of incontinence. Issues were also raised of the organization and nature of the advisers work load.

An investigation of recognized incontinence within a health authority

“…It was apparent dunng tbe interviews tbat many people were in need of advice and instruction in relation to continence management When asked wbo tbey would approacb for advice on tbe management of incontinence, 38 6% said tbey did not know Wbile 34 4% said tbey would ask their GP for advice, more than half added that tbey were unsure if tbeir GP could belp 15 9% said bospital doctor, 2 3% distnct nurse, 2 3% bealtb visitor, 2 3% social worker, 2 3% special scbool beadmistress CONCLUSION Tbis study examined tbe service offered to incontinent persons m one bealtb autbority Tbe service itself was a basic one, providing only disposable incontinence products to a large proportion of tbe people it served, tbus addressing tbe treatment of tbe symptoms ratber tban tbe prevention and cure of tbe underlying cause Tbe implications of such a service are clearly wide-reacbmg and as a result of tbe cnsis style of management may mdeed be more expensive to run in tbe long-term tban a comprebensive continence service addressing tbe issues of prevention and cure This, of course, would be extremely difficult to prove (Badger et al 1983) but tbe argument is logically appealing and one wbich is often used to support specialist appointments wbere emphasis is focused on prevention ratber tban cure, particularly as tbe cballenge of sbifting empbasis from an illness service to a bealtb service faces tbe Britisb Nahonal Healtb Service (Department of Healtb and Social Secunty 1987) Tbe service was found to provide assistance to a very small proportion (0 47%) of tbe population served by tbe bealtb autbority Wbile tbe present study and tbat of Tbomas et al (1980) were camed out using different study populations, tbe results of tbe latter study indicate tbat around 8% of tbe adult population may suffer from mconhnence Tbus, if only 1% of tbose people tbougbt to suffer from tbe symptom come forward for treatment, tbe service would face a 50% nse m requests for incontinence products, putting financial strain on an already hgbt budget Tbe service, as one manager stated, bad musbroomed as 'word about it bad spread' Tbus it is not inconceivable tbat tbis trend could contmue Tbe current management bebind tbe service clearly necessitated close examination…”