title: Are women's needs being met by specialist health services managing urinary incontinence in the remote Top End NT?
abstract: BACKGROUND
  Urinary incontinence (UI) is likely to be high in Aboriginal women in rural Australia due to risk factors including high body mass index, parity and diabetes. However, UI appears to be under-reported with limited information on whether women access appropriate care.
  
  
  OBJECTIVE
  To assess whether women who access specialist gynaecological services in rural and remote Top End Northern Territory (NT) through the specialist outreach program (SONT) are receiving care for UI aligned with best practice.
  
  
  METHODS
  Review of all 1426 SONT referrals in 2012, with audit of management for those women referred for UI or prolapse.
  
  
  RESULTS
  Of 1426 SONT referrals, there were 43/1426 (3%) women referred for UI, with 34/43 (79%) attending. Of those referred, 31/43 (72%) were Aboriginal. Of twenty-six women diagnosed with probable stress UI, less than a fifth, 5/26 (19%), were referred to physiotherapy, with 2/5 (40%) attending appointments. Referral occurred for 14/23 (61%) of those suitable for urodynamics but only 6/14 (43%) attended. Just under half of women 7/16 (14%) with stress UI were referred for surgery, with 6/7 (86%) attending.
  
  
  CONCLUSIONS
  In rural and remote Top End NT, specialist health service management of female UI could be improved by increased provision of current best-practice and an integrated multi-disciplinary team approach with allied health. Under-reporting and under-referral for female UI could be addressed by increasing awareness among community and primary healthcare providers of the problem of female UI and the conservative, medical and surgical treatments available.
authors.affiliation: Department of O&G, Royal Darwin Hospital, Tiwi, Northern Territory, 0810, Australia.
authors.forename: Alexandra
authors.identifier: http://orcid.org/0000-0002-4944-728X
authors.initials: A
authors.lastname: Bonner
authors.affiliation: Monash Centre for Health Research and Implementation - MCHRI, Women's Public Health Research, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, 3168, Australia.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Boyle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003950:Diagnostic Techniques, Urological; D019317:Evidence-Based Medicine; D005081:Exercise Therapy; D005260:Female; D006176:Gynecology / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008485:Medical Audit; D008875:Middle Aged; D015876:Northern Territory; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000706:statistics & numerical data*; D017773:Pelvic Floor / Q000503:physiopathology; D056887:Pelvic Organ Prolapse / Q000150:complications / Q000628:therapy; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D019035:Rural Health Services / Q000592:standards* / Q000706:statistics & numerical data; D053825:Suburethral Slings; D014550:Urinary Incontinence, Stress / Q000150:complications / Q000208:ethnology / Q000628:therapy*; D053202:Urinary Incontinence, Urge / Q000150:complications / Q000208:ethnology / Q000628:therapy*; D014563:Urodynamics; D000095283:Australian Aboriginal and Torres Strait Islander Peoples
keywords: Aboriginal population; delivery of health care; female urinary incontinence; health services; rural health