Adherence to professional guidelines for patients with urinary incontinence by general practitioners: a cross-sectional study.
BACKGROUND
Urinary incontinence is a common problem, affecting quality of life and leading to high costs. There is doubt about the use of clinical practice guidelines on urinary incontinence in primary care.


OBJECTIVE
To assess adherence levels and reasons for (non)adherence to the Guideline on Urinary Incontinence of the Dutch College of General Practitioners. Design, setting and participants A postal survey among Dutch general practitioners (GPs).


METHODS
Adherence of GPs to the guideline.


RESULTS
We analysed 264 questionnaires. Almost all GPs adhered to the guideline when diagnosing the type of urinary incontinence. A bladder diary is not often used (35%). Adherence to therapeutic procedures was only high for mild/moderate stress urinary incontinence: most GPs (82.6%) used adequate advice on bladder retraining and pelvic floor muscle training. One out of four GPs agreed that adhering to the guideline is difficult, mainly owing to lack of time, staff, diagnostic tools, competences to provide this care and low motivation of patients.


CONCLUSIONS
Dutch GPs follow the guideline only partially: compliance with diagnostic advices is fairly good; compliance with treatment advices is low. Further research should focus on solutions how to support GPs to tackle major barriers to facilitate the adherence to guidelines (substitution of tasks to specialized nurses, reducing the threshold for referral and concentrating expertise in integrated continence care services).
Albers-Heitner
Pytha
P
Integrated Care Unit, University Hospital Maastricht, Maastricht, The Netherlands. c.albers@caphri.unimaas.nl
Berghmans
Bary
B
Nieman
Fred
F
Lagro-Janssen
Toine
T
Winkens
Ron
R
D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D019317:Evidence-Based Medicine / Q000193:education; D005081:Exercise Therapy; D005194:Family Practice / Q000193:education / Q000458:organization & administration; D005260:Female; D019983:Guideline Adherence / Q000458:organization & administration*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008499:Medical Records; D015999:Multivariate Analysis; D009426:Netherlands; D017773:Pelvic Floor; D010821:Physicians, Family / Q000193:education / Q000458:organization & administration / Q000523:psychology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000458:organization & administration; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D013997:Time Factors; D014549:Urinary Incontinence / Q000175:diagnosis / Q000628:therapy