Clinical and cost-effectiveness of a new nurse-led continence service: a randomised controlled trial.
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.
Williams
Kate S
KS
University of Leicester, Leicester. ksw6@le.ac.uk
Assassa
R Phil
RP
Cooper
Nicola J
NJ
Turner
David A
DA
Shaw
Christine
C
Abrams
Keith R
KR
Mayne
Christopher
C
Jagger
Carol
C
Matthews
Ruth
R
Clarke
Michael
M
McGrother
Catherine W
CW
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