title: Improving continence services for older people from the service-providers' perspective: a qualitative interview study.
abstract: OBJECTIVE
  To examine in depth the views and experiences of continence service leads in England on key service and continence management characteristics in order to identify and to improve our understanding of barriers to a good-quality service and potential facilitators to develop and to improve services for older people with urinary incontinence (UI).
  
  
  METHODS
  Qualitative semistructured interviews using a purposive sample recruited across 16 continence services.
  
  
  METHODS
  3 acute and 13 primary care National Health Service Trusts in England.
  
  
  METHODS
  16 continence service leads in England actively treating and managing older people with UI.
  
  
  RESULTS
  In terms of barriers to a good-quality service, participants highlighted a failure on the part of commissioners, managers and other health professionals in recognising the problem of UI and in acknowledging the importance of continence for older people and prevalent negative attitudes towards continence and older people. Patient assessment and continence promotion regardless of age, rather than pad provision, were identified as important steps for a good-quality service for older people with UI. More rapid and appropriate patient referral pathways, investment in service capacity, for example, more trained staff and strengthened interservice collaborations and a higher profile within medical and nurse training were specified as being important facilitators for delivering an equitable and high-quality continence service. There is a need, however, to consider the accounts given by our participants as perhaps serving the interests of their professional group within the context of interprofessional work.
  
  
  CONCLUSIONS
  Our data point to important barriers and facilitators of a good-quality service for older people with UI, from the perspective of continence service leads. Further research should address the views of other stakeholders, and explore options for the empirical evaluation of the effectiveness of identified service facilitators.
authors.affiliation: School of Health and Related Research Sheffield, University of Sheffield, Sheffield, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Orrell
authors.forename: Kevin
authors.initials: K
authors.lastname: McKee
authors.forename: Lena
authors.initials: L
authors.lastname: Dahlberg
authors.forename: Mary
authors.initials: M
authors.lastname: Gilhooly
authors.forename: Stuart
authors.initials: S
authors.lastname: Parker
keywords: Geriatric Medicine
references.citation: Med Anthropol Q. 1995 Jun;9(2):188-210
references.pmid: 7671114
references.citation: Br J Gen Pract. 2005 Sep;55(518):696-703
references.pmid: 16176737
references.citation: Urology. 2004 Mar;63(3 Suppl 1):42-4
references.pmid: 15013651
references.citation: Urology. 2010 Mar;75(3):491-500
references.pmid: 19962738
references.citation: J Adv Nurs. 2013 Nov;69(11):2423-31
references.pmid: 23517523
references.citation: BMJ. 2001 Mar 17;322(7287):668-70
references.pmid: 11250856
references.citation: BMJ. 2000 Jan 8;320(7227):114-6
references.pmid: 10625273
references.citation: Age Ageing. 2009 Nov;38(6):730-3
references.pmid: 19793925
references.citation: Age Ageing. 2012 Jan;41(1):35-40
references.pmid: 21948857
references.citation: Age Ageing. 1997 Sep;26(5):367-74
references.pmid: 9351481
references.citation: BJU Int. 2003 Nov;92(7):731-5
references.pmid: 14616456
references.citation: Urology. 2010 Aug;76(2):265-70
references.pmid: 20541241
references.citation: Neurourol Urodyn. 2006;25(3):290-292
references.pmid: 16496393
references.citation: Neurourol Urodyn. 2002;21(2):167-78
references.pmid: 11857671
references.citation: Int J Nurs Pract. 2000 Apr;6(2):62-9
references.pmid: 11111490
references.citation: BJU Int. 2004 Feb;93(3):324-30
references.pmid: 14764130
references.citation: Br J Gen Pract. 1998 Feb;48(427):975-7
references.pmid: 9624768
references.citation: BJU Int. 2009 Jan;103(2):202-9
references.pmid: 19278532
references.citation: Int Urogynecol J Pelvic Floor Dysfunct. 2000;11(5):301-19
references.pmid: 11052566
references.citation: Psychol Health. 2010 Dec;25(10):1229-45
references.pmid: 20204937
references.citation: Eur J Obstet Gynecol Reprod Biol. 2007 Sep;134(1):120-5
references.pmid: 16934382
references.citation: Gerontologist. 2001 Oct;41(5):576-7; discussion 580
references.pmid: 11574699
references.citation: Neurourol Urodyn. 2013 Apr;32(4):314-24
references.pmid: 23129242
references.citation: Neurourol Urodyn. 2010;29(1):165-78
references.pmid: 20025027
references.citation: Int J Nurs Pract. 2006 Oct;12(5):273-9
references.pmid: 16942515
references.citation: BJU Int. 2004 Apr;93(6):763-9
references.pmid: 15049987
references.citation: Intern Med J. 2011 Apr;41(4):308-14
references.pmid: 20002850
references.citation: J Eval Clin Pract. 2008 Oct;14(5):836-8
references.pmid: 19018916
references.citation: J Eval Clin Pract. 2009 Apr;15(2):341-5
references.pmid: 19335495
references.citation: Int J Older People Nurs. 2009 Mar;4(1):70-5
references.pmid: 20925805
references.citation: J Public Health Med. 2000 Sep;22(3):427-34
references.pmid: 11077920
references.citation: Fam Pract. 2007 Oct;24(5):461-7
references.pmid: 17670805
references.citation: Nurs Stand. 2004 Nov 10-16;19(9):45-51, quiz 52
references.pmid: 15574054
references.citation: BMJ. 2009 Dec 08;339:b4914
references.pmid: 19995819
references.citation: Aging Male. 2000 Sep;3(3):143-54
references.pmid: 16760150
references.citation: Rural Remote Health. 2005 Apr-Jun;5(2):390
references.pmid: 15913450
references.citation: Health Technol Assess. 2006 Feb;10(6):1-132, iii-iv
references.pmid: 16487456
references.citation: Qual Manag Health Care. 2005 Jul-Sep;14(3):167-76
references.pmid: 16027595