title: The design and initial patient evaluation of an integrated care pathway for faecal incontinence: a qualitative study.
abstract: BACKGROUND
  Faecal incontinence is a common, distressing and debilitating condition which remains largely hidden, leading to social isolation and loss of confidence. Patients with faecal incontinence experience delays in accessing appropriate treatment services due to embarrassment and lack of enquiry from primary care health professionals. Despite the publication of three government documents related to continence services in the last decade, these services are still fragmented with asynchronous delivery and poor inter-professional integration. The aim of the study was to describe a novel integrated care pathway for the management of faecal incontinence and examine the experiences of patients with faecal incontinence in relation to this pathway.
  
  
  METHODS
  A focus group (eight participants) and narrative, qualitative individual interviews (five participants) were used to explore the views of patients with faecal incontinence, relating to access and quality of incontinence services and the new integrated care pathway. Emerging themes were identified from the transcribed focus group and interviews via the thematic analysis method.
  
  
  RESULTS
  The concept of an integrated care pathway is attractive for increasing accessibility, streamlining of the patient pathway and providing a dedicated service for the management of faecal incontinence. Patients' initial experiences of the pathway are positive.
  
  
  CONCLUSIONS
  A new ICP was developed and the initial patient evaluation of it was positive. Service users made various suggestions how the FI pathway could have been improved. The issues that patients were most concerned about were access to continence services, GP awareness of continence services and prompt, effective management of their condition. This service was set up within the pelvic floor dysfunction unit with BFNS and an integrated community continence team. The authors are aware that this is not a standard service setup across the country. The fact that it may be uncomfortable for patients to talk about their condition may have led to potential bias when discussing their beliefs or experiences. As with most qualitative studies, our aim was to identify a range of experiences rather than define our participant sample as being representative. Our participant sample was diverse in the key characteristics but a longitudinal study may reveal further important aspects of an ICP for FI.
  
  
  CONCLUSIONS
  An integrated care pathway for faecal incontinence appears to have potential to address the long-standing service delivery issues that have blighted continence services historically.
authors.affiliation: Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK. craig.rimmer@nhs.net.
authors.forename: Craig John
authors.initials: CJ
authors.lastname: Rimmer
authors.affiliation: Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK. kathryn.gill@nhs.net.
authors.forename: Kathryn Ann
authors.initials: KA
authors.lastname: Gill
authors.affiliation: University of Birmingham, Birmingham, UK. s.m.greenfield@bham.ac.uk.
authors.forename: Sheila
authors.initials: S
authors.lastname: Greenfield
authors.affiliation: University of Birmingham, Birmingham, UK. g.dowswell@bham.ac.uk.
authors.forename: George
authors.initials: G
authors.lastname: Dowswell
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001364:Awareness; D019091:Critical Pathways / Q000458:organization & administration*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D004739:England; D004812:Epidemiologic Methods; D005242:Fecal Incontinence / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000458:organization & administration; D012649:Self Concept