The effects of involving a nurse practitioner in primary care for adult patients with urinary incontinence

• Register: ISRCTN
• Last refreshed on: 13 January 2015
• Main ID: ISRCTN62722772
• Date of registration: 20/12/2005
• Prospective Registration: No
• Primary sponsor: University Hospital Maastricht (The Netherlands)
• Public title: The effects of involving a nurse practitioner in primary care for adult patients with urinary incontinence
• Date of first enrolment: 01/12/2004
• Target sample size: 350
• Recruitment status: Completed
• URL: http://isrctn.com/ISRCTN62722772
• Study type: Interventional
• Study design: Randomissed controlled trial (Not Specified)

Countries of recruitment

Netherlands

Contacts

• Name: Ron A G Winkens

Key inclusion & exclusion criteria

Inclusion criteria: All consecutive patients (both male and female) consulting their GP within one year for symptoms and signs of stress, urge and mixed urinary incontinence (according to the guidelines of the Dutch College of General Practitioners on urinary incontinence).
Exclusion criteria: 1. Patients below 18
2. Women with prolaps degree III or more
3. Patients with signs of reflex- or overflow incontinence
4. Patients with tumours in the abdomen
5. Patients with severe neurological diseases associated with incontinence (multiple sclerosis, CVA, diabetes, cauda equina syndrome), actual urinary tract infection, hematuria without urinary tract infection
6. Men below 65 with unclear reason for incontinence
7. Failure after operation or failure of conservative therapy
8. Severe cognitive problems
9. Patients not well versed in the Dutch language
10. Patients who refuse to participate/cooperate
11. Patients for whom the GP considers the management via the nurse practitioner as impossible/undesired, or unexpected circumstances not related to the trial (such as moving away, sickness)

Age minimum:
Age maximum:
Gender: Both

Health Condition(s) or Problem(s) studied

Urinary incontinence
Urological and Genital Diseases
Unspecified urinary incontinence

Intervention(s)

Please note that, as of 30/04/2008, the anticipated end date of this trial was amended from 30/11/2007 to 01/07/2008.

In this pragmatic trial the intervention is designed as close as possible to treatment options in clinical practice (including 'cascades' of patient management choices). This way implementation in the future is easier.

When the patient is allocated to the intervention group the GP has the availability to refer the patient to the nurse practitioner according to a precisely described care protocol.

The main goal of the intervention of the nurse practitioner is to provide a tailored, patient specific diagnostic and treatment plan to all eligible patients, thereby preventing or reducing the use of incontinence pads. Based on guidelines and protocols the nurse practitioner takes over from the GP tasks related to diagnostics, intervention and monitoring of incontinence.

Furthermore, the nurse practitioner supports patients motivation, compliance and adherence both on the short and the long term by monitoring patients over time in a systematic way to ensure that patients will accept, understand, are willing and able to do and actually do and keep doing or following up advices on lifestyle and bladder- and/or pelvic floor muscle training according to a health education model.

Another task of the nurse practitioner is to give adequate information and advice about (when still necessary) the choice and the use of non-curative means like incontinence pads. She/he will always report to the GP and acts as the contact person between the other healthcare providers. In case of unclear pathology, a complex health problem or failure of treatment the nurse practitioner can advice a referral to a specialist or specialised physiotherapist.

In all cases, the decisions for referral is at the GP. Altogether this means that a regular meeting between nurse practitioner and GP to discuss patients is needed.

Primary Outcome(s)

1. Severity of involuntary loss of urine: measured by the self-completed condition specific International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) which measures frequency, volume and impact on daily life of involuntary urine loss (see supplement for questions and scoring). The outcome is a sum score of the first two weighted items and the VAS score of impact on daily life. The questionnaire underwent extensive psychometric testing. It is expected that the International Consultation on Incontinence (ICI) will rate this questionnaire as Grade A, meaning highly recommendable.
2. Medical costs (the use of diagnostics, treatment and incontinence pads) and non-medical costs (productivity costs, time costs and travel costs): collected using both registration systems and cost diaries during four weeks.

Secondary Outcome(s)

1. Quality of life: a) Condition specific self-completed quality of life questionnaire: International Incontinence Questionnaire (IIQ): this in Dutch validated 30 items questionnaire measures impact of urinary loss on five domains: ?mobility?, ?physical functioning?, ?social functioning?, ?emotional health? and ?embarrassment?. b) Generic self-completed quality of life questionnaire.
2. Quantification of symptoms relevant for urinary incontinence (the degree of pad usage times of micturation, voided volumes, incontinence episodes, fluid intake, the degree of urgency, complications, complaints): measured with a self completed bladder diary during 3 consecutive days.
3. Patients satisfaction with provided care by the GP and/or the nurse practitioner for urinary incontinence will be measured with the for urinary incontinence adjusted QUOTE self completed questionnaire.
4. Perceptions of GPs about the availability and involvement of the route via the nurse practitioner: data of a sample of participating GPs will be collected by semi-structured interview and/or questionnaires before, once during the first 2 months and after the study about ideas/expectations, promoting and /or hampering factors for (not) using the nurse practitioner and experiences in relation to quality of care with the nurse practitioner.
5. Perceptions of nurse practitioners: data of participating nurse practitioners will be collected with semi-structured interview and/or questionnaires before, during and after the study about ideas/expectations and experiences in relation to quality of care.

Secondary ID(s)

N/A

Source(s) of Monetary Support

The Netherlands Organization for Health Research and Development (ZonMw) (The Netherlands)