Button D, Roe B, Webb C, Frith T, Colin-Thome D, Gardner L
School of Nursing Studies, The University, Manchester, England.
J Adv Nurs. 1998 Jan;27(1):91-9. doi: 10.1046/j.1365-2648.1998.00505.x.
A project was undertaken as part of the NHS Executive Strategy for Major Clinical Guidelines, involving the development of national clinical guidelines for the promotion and management of continence by primary health care teams, through the process of managed consensus based on scientific review. The guidelines were then implemented at one urban general practice. This article outlines the development and implementation of the guidelines and describes the study undertaken to evaluate the impact of implementation on clinical outcomes. The study involved a pre-and post-implementation postal survey of a random sample of 17% of patients aged 18 years and over from the practice (n = 1503). The pre-implementation survey determined the period prevalence of incontinence, related biological data and data on the pre-implementation management of incontinence. Incontinence sufferers were invited to have their condition assessed or reviewed. All sufferers who agreed to be followed-up were sent the post-implementation survey, which identified those patients who had sought help, and ascertained reasons for not seeking help. Data on the management of incontinence post-implementation were also obtained. Clinical outcomes measured pre- and post-implementation were a validated severity index for urinary incontinence, (also adapted for faecal incontinence) and perception of the incontinence as a problem. A 3-month period was allowed between pre- and post-implementation surveys. The study confirmed previous research which showed that few incontinence sufferers respond to invitations to seek help, and that help-seeking behaviour was significantly related to severity of incontinence. The guidelines did not have any positive impact on the clinical outcomes measured, although slight improvements in approaches taken by the primary health care team to the promotion and management of continence were recorded. However, the study was limited by the small sample size and short time scale. Further evaluation of the impact of the guidelines on these outcomes is therefore recommended.
作为英国国家医疗服务体系（NHS）重大临床指南执行战略的一部分，开展了一个项目，该项目涉及通过基于科学审查的管理共识过程，制定由初级卫生保健团队促进和管理尿失禁的国家临床指南。然后在一个城市全科诊所实施这些指南。本文概述了指南的制定和实施情况，并描述了为评估实施对临床结果的影响而进行的研究。该研究包括对该诊所17%的18岁及以上患者随机样本进行实施前和实施后的邮寄调查（n = 1503）。实施前的调查确定了尿失禁的期间患病率、相关生物学数据以及尿失禁实施前的管理数据。邀请尿失禁患者对其病情进行评估或复查。所有同意接受随访的患者都收到了实施后的调查问卷，该问卷确定了那些寻求帮助的患者，并查明了未寻求帮助的原因。还获得了实施后尿失禁管理的数据。实施前和实施后测量的临床结果是一个经过验证的尿失禁严重程度指数（也适用于大便失禁）以及将尿失禁视为一个问题的认知。在实施前和实施后的调查之间留出了3个月的时间。该研究证实了先前的研究，即很少有尿失禁患者响应寻求帮助的邀请，并且寻求帮助的行为与尿失禁的严重程度显著相关。尽管记录到初级卫生保健团队在促进和管理尿失禁方面采取的方法略有改进，但这些指南对所测量的临床结果没有任何积极影响。然而，该研究受到样本量小和时间尺度短的限制。因此，建议进一步评估这些指南对这些结果的影响。
