The Handling of Urinary Incontinence in Danish General Practices After Distribution of Guidelines and Voiding Diary Reimbursement: an Observational Study

Overview

Journal BMC Fam Pract

Publisher Biomed Central

Specialties Health Services
Public Health

Date 2004 Jul 1

PMID 15225353

Citations 3

Authors

Lars Viktrup

Lars Alling Moller

Affiliations

Soon will be listed here.

Abstract

Background: Though urinary incontinence (UI) is a bothersome condition for the individual patient, the patients tend not to inform their physician about UI and the physician tend not to ask the patient. Recently different initiatives have been established in Danish general practices to improve the management of UI. The aim of this study was to identify the handling of urinary incontinence (UI) in Danish general practices after distribution of clinical guidelines and reimbursement for using a UI diary.

Methods: In October 2001, a questionnaire was sent to 243 general practitioners (GPs) in Frederiksborg County following distribution of clinical guidelines in July 1999 (UI in general practice) and September 2001 (UI in female, geriatric, or neurological patients). A policy for a small reimbursement to GPs for use of a fluid intake/voiding diary in the assessment of UI in general practice was implemented in October 2001. Information concerning monthly reimbursement for using a voiding diary, prescribed drugs (presumably used for treating UI), UI consultations in outpatient clinics, and patient reimbursement for pads was obtained from the National Health Service County Registry.

Results: Of the 132 (54%) GPs who replied, 87% had read the guidelines distributed 2 years before, but only 47% used them daily. The majority (69%) of the responding GPs had read and appreciated 1-3 other UI guidelines distributed before the study took place. Eighty-three percent of the responding GPs sometimes or often actively asked their patients about UI, and 92% sometimes or often included a voiding diary in the UI assessment. The available registry data concerning voiding diary reimbursement, prescribed UI drugs, UI consultations in outpatient clinics, and patient reimbursement for pads were insufficient or too variable to determine significant trends.

Conclusion: GPs management of UI in a Danish county may be reasonable, but low response rate to the questionnaire and insufficient registry data made it difficult to evaluate the impact of different UI initiatives.

Citing Articles

Which strategies support the effective use of clinical practice guidelines and clinical quality registry data to inform health service delivery? A systematic review.

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Developing an internationally-applicable service specification for continence care: systematic review, evidence synthesis and expert consensus.

Wagg A, Newman D, Leichsenring K, van Houten P PLoS One. 2014; 9(8):e104129.

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Addressing the need for a simpler algorithm for the management of women with urinary incontinence.

Viktrup L MedGenMed. 2005; 7(3):62.

PMID: 16369288 PMC: 1681655.

References

McFall S, Yerkes A, Bernard M, LeRud T . Evaluation and treatment of urinary incontinence. Report of a physician survey. Arch Fam Med. 1997; 6(2):114-9. DOI: 10.1001/archfami.6.2.114. View

Freemantle N, HARVEY E, Wolf F, Grimshaw J, Grilli R, Bero L . Printed educational materials: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2000; (2):CD000172. PMC: 10868503. DOI: 10.1002/14651858.CD000172. View

Kinchen K, Burgio K, Diokno A, Fultz N, Bump R, Obenchain R . Factors associated with women's decisions to seek treatment for urinary incontinence. J Womens Health (Larchmt). 2003; 12(7):687-98. DOI: 10.1089/154099903322404339. View

Jensen G, Walter S . [Urinary incontinence, a guideline--and so what?]. Ugeskr Laeger. 2000; 162(7):909. View

Dovey S, McNaughton T, Tilyard M, Gurr E, Jolleys J, Wilson D . General practitioners' opinions of continence care training. N Z Med J. 1996; 109(1029):340-3. View

Davis D, Taylor-Vaisey A . Translating guidelines into practice. A systematic review of theoretic concepts, practical experience and research evidence in the adoption of clinical practice guidelines. CMAJ. 1997; 157(4):408-16. PMC: 1227916. View

Lagace E, Hansen W, Hickner J . Prevalence and severity of urinary incontinence in ambulatory adults: an UPRNet study. J Fam Pract. 1993; 36(6):610-4. View

Viktrup L, Lose G . The risk of stress incontinence 5 years after first delivery. Am J Obstet Gynecol. 2001; 185(1):82-7. DOI: 10.1067/mob.2001.114501. View

Welz-Barth A, Fusgen I, Melchior H . 1999 rerun of the 1996 German Urinary Incontinence Survey: will doctors ever ask?. World J Urol. 2001; 18(6):436-8. DOI: 10.1007/pl00007087. View

10.

Viktrup L, Bump R . Pharmacological agents used for the treatment of stress urinary incontinence in women. Curr Med Res Opin. 2003; 19(6):485-90. DOI: 10.1185/030079903125002126. View

11.

Grol R, Dalhuijsen J, Thomas S, Veld C, Rutten G, Mokkink H . Attributes of clinical guidelines that influence use of guidelines in general practice: observational study. BMJ. 1998; 317(7162):858-61. PMC: 31096. DOI: 10.1136/bmj.317.7162.858. View

12.

Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U . The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002; 21(2):167-78. DOI: 10.1002/nau.10052. View

13.

Thomson OBrien M, Oxman A, Davis D, Haynes R, Freemantle N, HARVEY E . Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2000; (2):CD000259. DOI: 10.1002/14651858.CD000259. View

14.

Grol R, Thomas S, Roberts R . Development and implementation of guidelines for family practice: lessons from The Netherlands. J Fam Pract. 1995; 40(5):435-9. View

15.

OBrien J, Austin M, Sethi P, OBoyle P . Urinary incontinence: prevalence, need for treatment, and effectiveness of intervention by nurse. BMJ. 1991; 303(6813):1308-12. PMC: 1671402. DOI: 10.1136/bmj.303.6813.1308. View

16.

Lose G, Jacobsen A, Madsen H, Thorsen P, Tibaek S, Johansen B . [General practitioners' knowledge of and attitude to assessment and treatment of women with urinary incontinence. A questionnaire among general practitioners in Denmark]. Ugeskr Laeger. 2001; 163(38):5183-8. View

17.

Seim A, Hermstad R, Hunskaar S . Female urinary incontinence: long-term follow-up after treatment in general practice. Br J Gen Pract. 1999; 48(436):1731-4. PMC: 1313262. View

18.

Bjerrum L, Larsen J, Kragstrup J . Guidelines accompanied by changes in reimbursement rules. Effects on lipid-lowering drug prescribing. Scand J Prim Health Care. 2001; 19(3):158-62. DOI: 10.1080/028134301316982379. View

19.

Gervas J, Perez Fernandez M, Starfield B . Primary care, financing and gatekeeping in western Europe. Fam Pract. 1994; 11(3):307-17. DOI: 10.1093/fampra/11.3.307. View

20.

Olesen F, Lauritzen T . Do general practitioners want guidelines? Attitudes toward a county-based and a national college-based approach. Scand J Prim Health Care. 1997; 15(3):141-5. DOI: 10.3109/02813439709018504. View