Effectiveness of involving a nurse specialist for patients with urinary incontinence in primary care: results of a pragmatic multicentre randomised controlled trial
Article first published online: 12 MAY 2011
© 2011 Blackwell Publishing Ltd
International Journal of Clinical Practice
Volume 65, Issue 6, pages 705–712, June 2011
How to Cite
Albers-Heitner, C. P., Lagro-Janssen, A. L. M., Joore, M. A., Berghmans, L. C. M., Nieman, F., Venema, P. L., Severens, J. L. and Winkens, R. A. G. (2011), Effectiveness of involving a nurse specialist for patients with urinary incontinence in primary care: results of a pragmatic multicentre randomised controlled trial. International Journal of Clinical Practice, 65: 705–712. doi: 10.1111/j.1742-1241.2011.02652.x
Disclosures All authors stated that they had no conflict of interest.
The affiliations 1, 3, 4 and 8 are involved in Maastricht University Medical Centre/CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
Ethical approval and clinical trial registration number
The study protocol was approved by the Medical Ethical Committees of all involved centres. Included patients gave their written informed consent. The trial is registered at http://www.controlled-trials.com/isrctn/62722772 and is reported following CONSORT guidelines for RCTs.
- Issue published online: 12 MAY 2011
- Article first published online: 12 MAY 2011
- Paper received November 2010, accepted February 2011
Background: Urinary incontinence (UI) primary care management is substandard, offering care rather than cure despite the existence of guidelines that help to improve cure. Involving nurse specialists on incontinence in general practice could be a way to improve care for UI patients.
Aims: We studied whether involving nurse specialists on UI in general practice reduced severity and impact of UI.
Methods: Between 2005 and 2008 a pragmatic multicentre randomised controlled trial was performed comparing a 1-year intervention by trained nurse specialists with care-as-usual after initial diagnosis and assessment by general practitioners in adult patients with stress, urgency or mixed UI in four Dutch regions (Maastricht, Nijmegen, Helmond, The Hague). Simple randomisation was computer-generated with allocation concealment. Analysis was performed by intention-to-treat principles. Main outcome measure was the International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI SF) severity sum score.
Results: A total of 186 patients followed the intervention and 198 received care-as-usual. Patients in both study groups improved significantly in UI severity and impact on health-related quality of life. After correction for effect modifiers [type of UI, body mass index (BMI)], we found significant differences between groups in favour of the intervention group at 3 months (p = 0.04); no differences were found in the 1-year linear trend (p = 0.15). Patients in the intervention group without baseline anxiety/depression improved significantly better compared with care-as-usual after 1 year (p = 0.03).
Conclusion: Involving nurse specialists in care for UI patients supplementary to general practitioners can improve severity and impact of UI, after correction for effect modifiers. This is also the case in specific situations such as anxiety/depression.