Continence Promotion Project
Improving Continence across Continents
Dr Cara Tannenbaum
Assistant Professor of Medicine, University of Montreal, Canada
This new UK-Canada synergy on incontinence will have 3 specific objectives:
Objective 1: To contribute evidence-based strategies for optimizing healthcare seeking for older adults with incontinence.
We will share our experience developing and testing Continence Promotion Workshops for Older Adults in Canada throughout the UK. Our intent is to adapt the workshops to the UK setting, and put in place a train-the-trainers program that can be disseminated by TACT collaborators throughout the country. We will also provide a new Self-Management Tool for Urinary Incontinence for testing and use by older adults. Research findings from Canada on concordant and discrepant perceptions of older patients and their providers3 for successfully treating incontinence will be discussed, and will be compared to work on this same topic being conducted in the UK as part of the TACT initiative.
Objective 2: To augment primary care for urinary incontinence in older adults.
Promoting more effective management of urinary incontinence requires a two-prong approach aimed not only at older adults, but at their primary care providers. Although there are evidence-based treatment options available, and cures obtainable at all ages, the majority of health care practitioners do not initiate discussion about incontinence with their patients. As a result, urinary incontinence is currently a significant healthcare challenge for both the Canadian and UK health delivery systems, with a clear need for improved strategy, within which medical education in primary care is a major element. The Canadian team proposes to spearhead the production of an instructional toolkit for clinicians (booklet and DVD) aimed at better diagnosing and treating incontinence for use by general practitioners in both countries. The development of this toolkit is being funded by a pedagogical knowledge transfer grant to Dr. Tannenbaum by the University of Montreal’s Geriatric Institute (2009-2010). The UK International Consultation on Incontinence Questionnaire (ICI-Q) working group has extensive experience with cultural adaptation of incontinence questionnaires and is keen to guide the Canadians in this mutually beneficial project. The applicants are well placed to support the introduction of this initiative. Dr. Marcus Drake, the primary UK co-applicant for this project, chairs the Urogenital Specialty Group of the the UK's Comprehensive Clinical Research Network (CCRN), an infrastructure investment covering the entire country, supporting systematic collaboration with the Primary Care Research Network. The introduction of the toolkit will be promoted through direct formal links with various key dissemination bodies. These bodies include the UK Pelvic Floor Clinical Studies Group, an interdisciplinary national collaboration of Urologists, Gynaecologists, Colorectal Surgeons, Nurses, Physiotherapists and Care of the Elderly Physicians, with active patient involvement; the Map of Medicine, which provides evidence-based and peer-reviewed pathways of medical management to practitioners in the UK and internationally; and finally, the website of the BJU International, one of the four main world-wide urology journals, which is developing a primary care area for education and interaction. This extensive interaction with primary care will maximize the dissemination of the Canadian initiatives and offer new insights into rapid and wide uptake.
Objective 3: Evaluating outcomes.
One of the core aims of the healthcare delivery component of the TACT3 programme is to support better service use outcomes by enhancing perceptions of control and efficacy in the older person. The UK working group for this aim is based in Sheffield under the directorship of Dr. Stuart Parker. The Canadian group will provide the Geriatric Self-Efficacy Index for Urinary Incontinence (GSE-UI), a new measurement tool to evaluate the outcomes for determining the effectiveness of various key elements of incontinence care desired by older adults, elicited by the research group in Sheffield. The GSE-UI was recently developed and validated in Canada as part of a CIHR operating grant to Dr. Tannenbaum but has never been tested in the UK. It measures the degree of confidence and control an older individual has for maintaining continence under different sets of circumstances. The UK is now focused on patient-reported outcome measures as the next key Government-introduced target, so introduction of the GSE-UI is a very timely initiative. It will be incorporated into the ICI-Q compendium of outcome tools for incontinence which currently includes several measures for incontinence, but none specifically developed for the elderly.
