Two models for delivery of women's continence care: the step-wise continence team versus the traditional medical model.

BACKGROUND: The current pyramidal system of health care delivery, in which subspecialized physicians with the most complete knowledge and expertise are difficult to access, is inefficient and ineffective at delivering the best care to the majority of patients. Urinary incontinence care exemplifies this problem. Patients can wait up to one year to see a urogynaecologist, regardless of the complexity of their problem. Many women who do not require subspecialized care could have their incontinence managed in a more timely fashion if they had access to education and conservative interventions via a new, more accessible model of care.

METHODS: We studied a modification of urinary incontinence care that departed from the traditional methods of care delivery in two distinct ways. First, patients were permitted to refer themselves directly to the specialty care team. Second, standardized questionnaires and evaluation tools facilitated assessment and management of the patients by a continence educator and nurses, without direct contact between patient and physician. This step-wise model of care was compared with the traditional method of care delivery (medical model), in which the management of all patients was provided by a physician.

RESULTS: Two hundred thirty-two women participated in this study: 154 in the step-wise arm and 78 in the medical model arm. Neither the demographics nor the pre-treatment incontinence severity of the two groups differed significantly. Patients in both groups showed significant improvement in all measures of urinary incontinence after treatment. Patients in the self-referral model experienced significantly better resolution of stress incontinence and irritated bladder symptoms. Their quality of life was also significantly better and their treatment satisfaction higher.

CONCLUSION: The step-wise model of care delivery involving a continence advisor and nurses was as effective in the management of urinary incontinence as the traditional medical model.