title: Clinical and cost-effectiveness of a new nurse-led continence service: a randomised controlled trial.
abstract: BACKGROUND
  Continence services in the UK have developed at different rates within differing care models, resulting in scattered and inconsistent services. Consequently, questions remain about the most cost-effective method of delivering these services.
  
  
  OBJECTIVE
  To evaluate the impact of a new service led by a continence nurse practitioner compared with existing primary/secondary care provision for people with urinary incontinence and storage symptoms.
  
  
  METHODS
  Randomised controlled trial with a 3- and 6-month follow-up in men and women (n = 3746) aged 40 years and over living in private households (intervention [n = 2958]; control [n = 788]).
  
  
  METHODS
  Leicestershire and Rutland, UK.
  
  
  METHODS
  The continence nurse practitioner intervention comprised a continence service provided by specially trained nurses delivering evidence-based interventions using predetermined care pathways. They delivered an 8-week primary intervention package that included advice on diet and fluids; bladder training; pelvic floor awareness and lifestyle advice. The standard care arm comprised access to existing primary care including GP and continence advisory services in the area. Outcome measures were recorded at 3 and 6 months post-randomisation.
  
  
  RESULTS
  The percentage of individuals who improved (with at least one symptom alleviated) at 3 months was 59% in the intervention group compared with 48% in the standard care group (difference of 11%, 95% CI = 7 to 16; P<0.001) The percentage of people reporting no symptoms or 'cured' was 25% in the intervention group and 15% in the standard care group (difference of 10%, 95% CI = 6 to 13, P = 0.001). At 6 months the difference was maintained. There was a significant difference in impact scores between the two groups at 3 and 6 months.
  
  
  CONCLUSIONS
  The continence nurse practitioner-led intervention reduced the symptoms of incontinence, frequency, urgency and nocturia at 3 and 6 months; impact was reduced; and satisfaction with the new service was high.
authors.affiliation: University of Leicester, Leicester. ksw6@le.ac.uk
authors.forename: Kate S
authors.initials: KS
authors.lastname: Williams
authors.forename: R Phil
authors.initials: RP
authors.lastname: Assassa
authors.forename: Nicola J
authors.initials: NJ
authors.lastname: Cooper
authors.forename: David A
authors.initials: DA
authors.lastname: Turner
authors.forename: Christine
authors.initials: C
authors.lastname: Shaw
authors.forename: Keith R
authors.initials: KR
authors.lastname: Abrams
authors.forename: Christopher
authors.initials: C
authors.lastname: Mayne
authors.forename: Carol
authors.initials: C
authors.lastname: Jagger
authors.forename: Ruth
authors.initials: R
authors.lastname: Matthews
authors.forename: Michael
authors.initials: M
authors.lastname: Clarke
authors.forename: Catherine W
authors.initials: CW
authors.lastname: McGrother
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005081:Exercise Therapy / Q000191:economics / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners / Q000191:economics; D017060:Patient Satisfaction; D017773:Pelvic Floor; D011788:Quality of Life; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000191:economics / Q000451:nursing* / Q000628:therapy