Viktrup Lars, Møller Lars Alling
The Research Unit for General Practice, Frederiksborg County, Denmark.
BMC Fam Pract. 2004 Jun 29;5:13. doi: 10.1186/1471-2296-5-13.
Though urinary incontinence (UI) is a bothersome condition for the individual patient, the patients tend not to inform their physician about UI and the physician tend not to ask the patient. Recently different initiatives have been established in Danish general practices to improve the management of UI. The aim of this study was to identify the handling of urinary incontinence (UI) in Danish general practices after distribution of clinical guidelines and reimbursement for using a UI diary.
In October 2001, a questionnaire was sent to 243 general practitioners (GPs) in Frederiksborg County following distribution of clinical guidelines in July 1999 (UI in general practice) and September 2001 (UI in female, geriatric, or neurological patients). A policy for a small reimbursement to GPs for use of a fluid intake/voiding diary in the assessment of UI in general practice was implemented in October 2001. Information concerning monthly reimbursement for using a voiding diary, prescribed drugs (presumably used for treating UI), UI consultations in outpatient clinics, and patient reimbursement for pads was obtained from the National Health Service County Registry.
Of the 132 (54%) GPs who replied, 87% had read the guidelines distributed 2 years before, but only 47% used them daily. The majority (69%) of the responding GPs had read and appreciated 1-3 other UI guidelines distributed before the study took place. Eighty-three percent of the responding GPs sometimes or often actively asked their patients about UI, and 92% sometimes or often included a voiding diary in the UI assessment. The available registry data concerning voiding diary reimbursement, prescribed UI drugs, UI consultations in outpatient clinics, and patient reimbursement for pads were insufficient or too variable to determine significant trends.
GPs management of UI in a Danish county may be reasonable, but low response rate to the questionnaire and insufficient registry data made it difficult to evaluate the impact of different UI initiatives.
尽管尿失禁对个体患者来说是一种困扰，但患者往往不向医生提及尿失禁情况，而医生也往往不主动询问患者。最近丹麦的普通诊所采取了不同举措来改善尿失禁的管理。本研究的目的是确定在发布临床指南以及对使用尿失禁日记给予报销之后，丹麦普通诊所对尿失禁的处理情况。
2001年10月，在1999年7月（普通诊所中的尿失禁）和2001年9月（女性、老年或神经科患者中的尿失禁）发布临床指南之后，向腓特烈斯贝格县的243名全科医生（GP）发送了一份调查问卷。2001年10月实施了一项政策，对全科医生在普通诊所评估尿失禁时使用液体摄入/排尿日记给予少量报销。从国家卫生服务县登记处获取了有关使用排尿日记的月度报销、处方药（可能用于治疗尿失禁）、门诊诊所的尿失禁咨询以及患者购买尿垫报销的信息。
在回复的132名（54%）全科医生中，87%阅读了两年前发布的指南，但只有47%每天使用这些指南。大多数（69%）回复的全科医生阅读并认可了在研究开展之前发布的其他1 - 3份尿失禁指南。83%回复的全科医生有时或经常主动询问患者是否有尿失禁情况，92%有时或经常在尿失禁评估中使用排尿日记。关于排尿日记报销、规定的尿失禁药物、门诊诊所的尿失禁咨询以及患者购买尿垫报销的现有登记数据不足或变化太大，无法确定显著趋势。
丹麦一个县的全科医生对尿失禁的管理可能是合理的，但调查问卷回复率低以及登记数据不足使得难以评估不同尿失禁举措的影响。
