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

Pytha Albers-Heitner (1) , Toine Lagro-Janssen (2) , Manuela Joore (3, 4) , Bary Berghmans (5) , Fred Nieman (3) , Pieter Venema (6) , Johan Severens (7) , Ron Winkens (8)

1 Department of Integrated Care
2 Department of Primary and Community Care
3 Department of Clinical Epidemiology and Medical Technology Assessment
4 Department of Health Organisation, Policy, and Economics
5 Pelvic care Centre Maastricht (PcCM)
6 Poliklinisch Continentie Centrum
7 Institute of Health Policy and Management
8 Department of General Practice

Abstract 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 one-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 done by intention-to-treat principles. Main outcome measure was the International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI SF) severity sum score. Results 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) we found significant differences between groups in favour of the intervention group at three months (p = 0.04); no differences were found in the one-year linear trend (p = 0.15). Patients in the intervention group without baseline anxiety/depression improved significantly better compared to care-as-usual after one 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.

Mots clés: Medicine

Pytha Albers-Heitner, Toine Lagro-Janssen, Manuela Joore, Bary Berghmans, Fred Nieman, et al.. 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, 2011, 65 (6), pp.705. ⟨10.1111/j.1742-1241.2011.02652.x⟩. ⟨hal-00640466⟩