title: Treatment by a nurse practitioner in primary care improves the severity and impact of urinary incontinence in women. An observational study.
abstract: BACKGROUND
  Urinary Incontinence (UI) is a common problem in women. The management of UI in primary care is time consuming and suboptimal. Shift of incontinence-care from General Practitioners (GP's) to a nurse practitioner maybe improves the quality of care. The purpose of this observational (pre/post) study is to determine the effectiveness of introducing a nurse practitioner in UI care and to explore women's reasons for not completing treatment.
  
  
  METHODS
  Sixteen trained nurse practitioners treated female patients with UI. All patients were examined and referred by the GP to the nurse practitioner working in the same practice. At baseline the severity of the UI (Sandvik-score), the impact on the quality of life (IIQ) and the impressed severity (PGIS) was measured and repeated after three months Differences were tested by the paired t and the NcNemar test. Reasons for not completing treatment were documented by the nurse practitioner and differences between the group that completed treatment and the drop-out group were tested.
  
  
  RESULTS
  We included 103 women, mean age 55 years (SD 12.6). The Sandvik severity categories improved significantly (P < 0.001), as did the impact on daily life (2.54 points, P = 0.012). Among the IIQ score the impact on daily activities increased 0.73 points (P = 0.032), on social functioning 0.60 points (P = 0.030) and on emotional well-being 0.63 points (P = 0.031). The PGIS-score improved in 41.3% of the patients. The most important reasons for not completing the treatment were lack of improvement of the UI and difficulties in performing the exercises. Women who withdraw from guidance by the nurse practitioner perceived more impact on daily life (P = 0.036), in particular on the scores for social functioning (P = 0.015) and emotional well-being (P = 0.015).
  
  
  CONCLUSIONS
  Treatment by a trained nurse practitioner seems positively affects the severity of the UI and the impact on the quality of life. Women who did not complete treatment suffer from more impact on quality of life, experience not enough improvement and mention difficulties in performing exercises.
authors.affiliation: Department Primary and Community Care, Gender & Women's Health, Radboud University Medical Centre Nijmegen, Internal postal code 118, P.O. Box 9101, , 6500 HB, Nijmegen, The Netherlands. doreth.teunissen@radboudumc.nl.
authors.forename: Doreth T A M
authors.initials: DT
authors.lastname: Teunissen
authors.affiliation: Department Primary and Community Care, Gender & Women's Health, Radboud University Medical Centre Nijmegen, Internal postal code 118, P.O. Box 9101, , 6500 HB, Nijmegen, The Netherlands. stegemanmarjolein@hotmail.com.
authors.forename: Marjolein M
authors.initials: MM
authors.lastname: Stegeman
authors.affiliation: Department Primary and Community Care, Gender & Women's Health, Radboud University Medical Centre Nijmegen, Internal postal code 118, P.O. Box 9101, , 6500 HB, Nijmegen, The Netherlands. Hans.Bor@radboudumc.nl.
authors.forename: Hans H
authors.initials: HH
authors.lastname: Bor
authors.affiliation: Department Primary and Community Care, Gender & Women's Health, Radboud University Medical Centre Nijmegen, Internal postal code 118, P.O. Box 9101, , 6500 HB, Nijmegen, The Netherlands. Toine.lagro-janssen@radboudumc.nl.
authors.forename: Toine A L M
authors.initials: TA
authors.lastname: Lagro-Janssen
mesh_terms: D005081:Exercise Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D009722:Nurse Practitioners; D010349:Patient Compliance; D017060:Patient Satisfaction; D059017:Primary Care Nursing / Q000379:methods*; D011788:Quality of Life; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000175:diagnosis* / Q000451:nursing*; D016387:Women's Health