Challenges in Urinary Incontinence Care: Importance of Community Continence Services

2. Urinary Incontinence in Community-Dwelling Populations: Issues & Challenges for Continence Care Assoc Prof Winsome St John RN, PhD School of Nursing & Midwifery Gold Coast Campus Research Centre for Clinical & Community Practice Innovation (RCCCPI)

3. Acknowledgements • Prof Marianne Wallis RN, PhD • Clinical Chair GCHSD & Griffith University • Shona McKenzie RN, BSc, AssDipHealthEd, PostGradCert in GeronotNurs, CNA, NP • Nurse Practitioner – continence, RBH • Susan Griffiths BA • Project manager, Griffith University • Heather James BN, MN • Research assistant, Griffith University • Waterworx Centre Clinical Team • Shona McKenzie • Sheridan Guyatt BPhyso • Jennifer Rayner RN, CNA, Stomal Therapist • Sue Walker RN, CNA • Lisa Sissons BPhysio

4. Why are community continence services important? • Epidemiology and an ageing population • The community is where people are • Policy issues • Demand for services will increase • Urinary incontinence is expensive • Urinary incontinence is a major reason for nursing home admission • Prevention - 1, 2  & 3 • Just because it is low tech, doesn’t mean it isn’t important • Urinary incontinence has a major impact

5. Impact of UI

6. Why are community continence services important? • Epidemiology and an ageing population • Policy issues • Demand will continue to increase • Urinary incontinence is expensive • Urinary incontinence is a major reason for nursing home admission • Prevention - 1, 2  & 3 • The community is where people are • Just because it is low tech, doesn’t mean it isn’t important • Urinary incontinence has a major impact • Continence services can make a difference

7. Primary Health Care … is essential care based on practical, scientifically sound and socially acceptable methods and technology made universally acceptable to individuals and families in the community through their full participation and at a cost that the community and country can afford … It brings health care close to where people live and work. World Health Organization. (1978). Declaration of Alma Ata: International conference on primary health care. Alma Ata, USSR, 6-12 September 1978. Retrieved on 28-10-2007 from <http://www.who.int/topics/primary_health_care/en//>

8. Primary health care • Effective • Acceptable • Accessible • Affordable • Appropriate

9. Australian context • National Continence Management Strategy • Continence Foundation Australia • National strategies eg. the National Helpline • A research agenda • Continence journal • Chronic diseases management strategies – nationally and in states • Many local initiatives

10. EffectivenessWhat has been achieved? • Research into effectiveness of therapies and treatments • More precise diagnostics • Evidence based clinical guidelines • First steps & second steps (HACC) • Assessment guidelines • Evaluation of demonstration projects and models of service delivery (St John & Mackenzie, 2002; St John et al, 2004; St John & Wallis, 2004) • Better research tools (Sansoni et al, 2006)

11. The Waterworx Model Promotion of client self - management Exercises / Pelvic floor retraining Multi-disciplinary assessment Targeting a community-dwelling client group Development of continence knowledge & health literacy Providing multi – disciplinary continence care Multidisciplinary case management Community- based services Comprehensive conservative management of UI tailored to community-based client needs Expertise, Specialist continence staff Facilitating Providing services within a generalist framework inter- disciplinary client Links to diagnostic & specialist services Ensuring collaboration access Providing services within a generalist framework Interdisciplinary referral Active promotion of service & linkages Development of multi-disciplinary Assessment tools Facility for self-referral Clinic & home visits Creating referral pathways Staff development & professional education Creating referral pathways St John, et. al, 2004 St John et al, 2004a