Holtzer-Goor K M, Gaultney J G, van Houten P, Wagg A S, Huygens S A, Nielen M M J, Albers-Heitner C P, Redekop W K, Rutten-van Mölken M P, Al M J
Erasmus University Rotterdam, Institute for Medical Technology Assessment / Institute of Health Policy and Management, Rotterdam, The Netherlands.
Zonnehuisgroep Amstelland, Medical department, Amstelveen, the Netherlands.
PLoS One. 2015 Oct 1;10(10):e0138225. doi: 10.1371/journal.pone.0138225. eCollection 2015.
Incontinence is an important health problem. Effectively treating incontinence could lead to important health gains in patients and caregivers. Management of incontinence is currently suboptimal, especially in elderly patients. To optimise the provision of incontinence care a global optimum continence service specification (OCSS) was developed. The current study evaluates the costs and effects of implementing this OCSS for community-dwelling patients older than 65 years with four or more chronic diseases in the Netherlands.
A decision analytic model was developed comparing the current care pathway for urinary incontinence in the Netherlands with the pathway as described in the OCSS. The new care strategy was operationalised as the appointment of a continence nurse specialist (NS) located with the general practitioner (GP). This was assumed to increase case detection and to include initial assessment and treatment by the NS. The analysis used a societal perspective, including medical costs, containment products (out-of-pocket and paid by insurer), home care, informal care, and implementation costs.
With the new care strategy a QALY gain of 0.005 per patient is achieved while saving €402 per patient over a 3 year period from a societal perspective. In interpreting these findings it is important to realise that many patients are undetected, even in the new care situation (36%), or receive care for containment only. In both of these groups no health gains were achieved.
Implementing the OCSS in the Netherlands by locating a NS in the GP practice is likely to reduce incontinence, improve quality of life, and reduce costs. Furthermore, the study also highlighted that various areas of the continence care process lack data, which would be valuable to collect through the introduction of the NS in a study setting.
尿失禁是一个重要的健康问题。有效治疗尿失禁可使患者和护理人员的健康状况得到显著改善。目前尿失禁的管理并不理想，尤其是在老年患者中。为了优化尿失禁护理服务，制定了全球最佳尿失禁服务规范（OCSS）。本研究评估了在荷兰为65岁以上患有四种或更多慢性病的社区居民实施该OCSS的成本和效果。
建立了一个决策分析模型，将荷兰目前的尿失禁护理路径与OCSS中描述的路径进行比较。新的护理策略是指定一名尿失禁专科护士（NS）与全科医生（GP）合作。这被认为可以提高病例检出率，并包括由NS进行的初始评估和治疗。分析采用社会视角，包括医疗成本、护理用品（自付和保险公司支付）、家庭护理、非正式护理和实施成本。
从社会角度来看，采用新的护理策略，每位患者的质量调整生命年（QALY）增加0.005，同时在3年期间每位患者节省402欧元。在解释这些结果时，重要的是要意识到，即使在新的护理情况下，仍有许多患者未被发现（36%），或者仅接受护理用品护理。在这两组患者中，均未实现健康状况的改善。
在荷兰通过在全科医生诊所设置一名NS来实施OCSS，可能会减少尿失禁，提高生活质量，并降低成本。此外，该研究还强调，尿失禁护理过程的各个领域都缺乏数据，通过在研究环境中引入NS来收集这些数据将很有价值。
