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

Authors

  • C. P. Albers-Heitner,

    1. Department of Integrated Care, Maastricht University Medical Centre, Maastricht, The Netherlands
    Search for more papers by this author
  • A. L. M. Lagro-Janssen,

    1. Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
    Search for more papers by this author
  • M. A. Joore,

    1. Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
    2. Department of Health Organisation, Policy, and Economics, Maastricht University Medical Centre, Maastricht, The Netherlands
    Search for more papers by this author
  • L. C. M. Berghmans,

    1. Pelvic care Centre Maastricht (PcCM), Maastricht University Medical Centre, Maastricht, The Netherlands
    Search for more papers by this author
  • F. Nieman,

    1. Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
    Search for more papers by this author
  • P. L. Venema,

    1. Poliklinisch Continentie Centrum, HAGA Hospital, The Hague, The Netherlands
    Search for more papers by this author
  • J. L. Severens,

    1. Department of Health Organisation, Policy, and Economics, Maastricht University Medical Centre, Maastricht, The Netherlands
    2. Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
    Search for more papers by this author
  • R. A. G. Winkens

    1. Department of Integrated Care, Maastricht University Medical Centre, Maastricht, The Netherlands
    2. Department of General Practice, Maastricht University Medical Centre, Maastricht, The Netherlands
    Search for more papers by this author

  • Linked Comment: www.youtube.com/IJCPeditorial, Michie. Int J Clin Pract 2011; 65: 635-7.

  • 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.

Pytha (C.P.) Albers-Heitner, MSc, PPT®, Researcher, Department of Integrated Care (MECC, 1.85.025), Maastricht University Medical Centre, Gaetano Martinolaan 85, PO Box 5800, 6202 AZ Maastricht, The Netherlands
Tel.: + 31 43 3877547
Fax: + 31 43 3874438 Email: c.albers@maastrichtuniversity.nl

Summary

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.

Ancillary