A major report, which examines how best to organise community care for people with incontinence, suggests there could be significant benefits for patients and the health and social care system if greater emphasis is placed on continence by policy makers and payers, and a more integrated approach is taken to assessment and treatment.
The findings of the ‘Optimum Continence Service Specification’, initiated by SCA, the leading global hygiene company, are particularly pertinent in light of the growing pressure on healthcare budgets and the rising challenge presented by an ageing population. Urinary and faecal incontinence currently affects at least 400 million people worldwide and incidence is likely to rise sharply in the coming years.
Explained Mansoor Parvaiz, Vice President, Incontinence Care at SCA: “Incontinence is a health and social care issue with significant impact on sufferers, their caregivers and local health economies, yet continence care is not currently receiving the focus or the funding that it deserves by health systems worldwide.
“The thinking behind this study was to address the gap that exists regarding clear guidance for payers and providers across the globe about how best to configure services to deliver cost effective, evidence based and high quality patient centred care.”
Weaknesses in current approaches to continence care
The report demonstrates a number of weaknesses in the current approach to continence care, some of which relate to the way that support is delivered. For instance, evidence shows that the best performing healthcare services are locally led in primary care by healthcare practitioners with specialist continence training, such as continence nurse specialists, rather than general primary care physicians. There is insufficient emphasis on appropriate professional training to enable initial assessment and treatment to be delivered in the community. The interaction between health and social care needs in people with continence problems is often overlooked while the use of containment products is often inconsistent and insensitive to the needs of patients and care givers.
Additionally, there is insufficient emphasis on self-management of the condition alongside specialist support, which could be used to empower sufferers and reduce the cost of care. Similarly, advancements in technology have seldom been harnessed to enhance delivery of care, when they have the potential to make a real difference to professionals and patients alike.
A new care pathway
The report makes a number of recommendations to improve the identification, assessment and treatment of incontinence, all of which can be adapted to suit local variations in practice, resources and culture around the globe. These include:
- The establishment of robust referral pathways to detect, assess and treat incontinence to provide timely and effective care.
- Shifting the responsibility for initial assessment and treatment away from general primary care physicians to healthcare professionals with specialist continence training, such as continence nurse specialists, or other clinicians as available, in primary care.
- Establishing accredited training programmes for nurses wanting to become continence nurse specialists and other health or social care professionals such as social workers who want to improve their competence in delivering continence care.
- Using case co-ordinators to ensure more collaborative working to reduce delays for patients with multiple morbidities connect specialists with other parts of the care pathway and strike a better balance between specialisations and holistic case management approaches.
- Promoting the use of self-management tools and techniques, providing information on the use of containment products and placing greater emphasis on shared decision making between healthcare provider and patient/care givers.
- Establishing comprehensive and standardised assessment processes to meet the needs of patients and caregivers with regards to the prescription of containment products.
- Making the use of technology, such as telehealth, integral to the delivery of continence care to enable self-care, connect patients and care givers and enable providers to monitor progress and troubleshoot problems.
- Adopting a more integrated approach to continence care where specialists are fully integrated with other parts of the care pathway
Finally, in order to improve standards in continence care, the report suggests that outcome and performance measures should be linked to financial incentives to motivate healthcare providers to provide the best possible care for patients. This would include sharing outcomes and performance data in the public domain and reporting results to patients, staff, payers and health systems administrators.
Anne-Sophie Parent, Secretary General at AGE PlatformEurope, which represents over 40 million older people in Europe:
“We welcome the initiative by SCA and the other parties involved in the Optimum Continence Care Specification, to place the spotlight on this important healthcare issue and encourage policy makers to make this a greater priority.
“Incontinence is a serious medical condition which carries an enormous stigma, yet many people suffer in silence due to shame. The recommendations in this report indicate that there is much more that can be done to raise the standards of care and dignity for patients. We hope that all those involved will draw on this report as valuable inspiration.”
Mansoor Parvaiz from SCA: “As this report demonstrates, the key to improving global standards of care for continence sufferers lies in adopting a more holistic, collaborative and integrated approach to assessment and treatment. This will not only benefit patients and their carers but also the wider economy. We hope this initiative will stimulate the debate and provide a helpful blueprint for policy makers, payers and clinicians across the globe as they strive to tackle this growing health and social care issue.”