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Addressing Urinary Incontinence: Community Continuity of Care Challenges and Solutions

This comprehensive overview highlights the issues and challenges surrounding urinary incontinence (UI) in community-dwelling populations. It emphasizes the need for effective continence services as UI is a significant factor leading to nursing home admissions and is costly for healthcare systems. The paper discusses the role of community continence care, citing relevant strategies, preventative methods, and the importance of multidisciplinary approaches. Collaborative care and tailored strategies are key to managing UI effectively and improving patient outcomes in the community setting.

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Addressing Urinary Incontinence: Community Continuity of Care Challenges and Solutions

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  1. Urinary Incontinence in Community-Dwelling Populations: Issues & Challenges for Continence Care Assoc Prof Winsome St John RN, PhD School of Nursing & Midwifery Gold Coast Campus Research Centre for Clinical & Community Practice Innovation (RCCCPI)

  2. Acknowledgements • Prof Marianne Wallis RN, PhD • Clinical Chair GCHSD & Griffith University • Shona McKenzie RN, BSc, AssDipHealthEd, PostGradCert in GeronotNurs, CNA, NP • Nurse Practitioner – continence, RBH • Susan Griffiths BA • Project manager, Griffith University • Heather James BN, MN • Research assistant, Griffith University • Waterworx Centre Clinical Team • Shona McKenzie • Sheridan Guyatt BPhyso • Jennifer Rayner RN, CNA, Stomal Therapist • Sue Walker RN, CNA • Lisa Sissons BPhysio

  3. Why are community continence services important? • Epidemiology and an ageing population • The community is where people are • Policy issues • Demand for services will increase • Urinary incontinence is expensive • Urinary incontinence is a major reason for nursing home admission • Prevention - 1, 2  & 3 • Just because it is low tech, doesn’t mean it isn’t important • Urinary incontinence has a major impact

  4. Impact of UI

  5. Why are community continence services important? • Epidemiology and an ageing population • Policy issues • Demand will continue to increase • Urinary incontinence is expensive • Urinary incontinence is a major reason for nursing home admission • Prevention - 1, 2  & 3 • The community is where people are • Just because it is low tech, doesn’t mean it isn’t important • Urinary incontinence has a major impact • Continence services can make a difference

  6. Primary Health Care … is essential care based on practical, scientifically sound and socially acceptable methods and technology made universally acceptable to individuals and families in the community through their full participation and at a cost that the community and country can afford … It brings health care close to where people live and work. World Health Organization. (1978). Declaration of Alma Ata: International conference on primary health care. Alma Ata, USSR, 6-12 September 1978. Retrieved on 28-10-2007 from <http://www.who.int/topics/primary_health_care/en//>

  7. Primary health care • Effective • Acceptable • Accessible • Affordable • Appropriate

  8. Australian context • National Continence Management Strategy • Continence Foundation Australia • National strategies eg. the National Helpline • A research agenda • Continence journal • Chronic diseases management strategies – nationally and in states • Many local initiatives

  9. EffectivenessWhat has been achieved? • Research into effectiveness of therapies and treatments • More precise diagnostics • Evidence based clinical guidelines • First steps & second steps (HACC) • Assessment guidelines • Evaluation of demonstration projects and models of service delivery (St John & Mackenzie, 2002; St John et al, 2004; St John & Wallis, 2004) • Better research tools (Sansoni et al, 2006)

  10. The Waterworx Model Promotion of client self - management Exercises / Pelvic floor retraining Multi-disciplinary assessment Targeting a community-dwelling client group Development of continence knowledge & health literacy Providing multi – disciplinary continence care Multidisciplinary case management Community- based services Comprehensive conservative management of UI tailored to community-based client needs Expertise, Specialist continence staff Facilitating Providing services within a generalist framework inter- disciplinary client Links to diagnostic & specialist services Ensuring collaboration access Providing services within a generalist framework Interdisciplinary referral Active promotion of service & linkages Development of multi-disciplinary Assessment tools Facility for self-referral Clinic & home visits Creating referral pathways Staff development & professional education Creating referral pathways St John, et. al, 2004 St John et al, 2004a

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