title: To what extent are national guidelines for the management of urinary incontinence in women adhered? Data from a national audit.
abstract: OBJECTIVE  To assess the degree of adherence to the current National Institute for Health and Clinical Excellence (NICE) guidelines on the management of urinary incontinence (UI) in women.
  
  
  METHODS
  Retrospective survey of consecutive female inpatients and outpatients with UI as part of a national audit.
  
  
  METHODS
  NHS hospital and primary care (PC) trusts.
  
  
  METHODS
  Twenty-five women <65 years old and 25 women ≥ 65 years old from each participating site.
  
  
  METHODS
  All NHS trusts in England, Wales and Northern Ireland were eligible to participate. A web-based data collection form aligned to the NICE guidelines was constructed for the study. All data submitted to the audit were anonymous and access to the web-tool was password-protected for confidentiality.
  
  
  RESULTS
  Data were returned by 128 acute and 75 PC trusts on 7846 women. No diagnosis was documented in 6.8% (153/2254) of younger and 28% (571/2011) of older women in hospitals (P < 0.001), and by 8.6% (123/1435) of younger and 21% (380/1786) of older women in PC trusts. In hospitals, 26% (396/1524) of younger women and 15% (182/1231) of older women (P < 0.001) and in PC trusts 8.2% (77/934) of younger and 4.7% (46/975) of older women underwent multichannel cystometry before conservative therapy. Documentation of discussion of causes and treatment of UI occurred in 76% (1717/2254) of younger and 44% (884/2011) of older women in hospitals (P < 0.001) and in 75% (1080/1435) of younger and 53% (948/1786) of older women in PC trusts (P < 0.001). CONCLUSION Older women are less likely to receive NICE compliant management. Adherence varies according to recommendation. There needs to be concentration on evidence-based community provision of care by competent and interested clinicians before the aims of the NICE guidelines are met.
authors: Division of Geriatric Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada. adrian.wagg@ualberta.ca
authors: A
authors: A
authors: Wagg
authors: J
authors: J
authors: Duckett
authors: D
authors: D
authors: McClurg
authors: D
authors: D
authors: Harari
authors: D
authors: D
authors: Lowe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D008485:Medical Audit; D008875:Middle Aged; D010353:Patient Education as Topic; D011182:Postoperative Care / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards*; D006113:United Kingdom; D014549:Urinary Incontinence / Q000209:etiology / Q000628:therapy*