“Targeting General Practitioners in Continence Care”
- by Diane Newman

Photo: Diane Newman, Jean Jacques Wyndaele,  Helmut Madersbacher, Elisabeth Willemina Bakker, Peter Lim, Nancy Muller, David Fonda, Christine Norton - Speakers at the workshop.


1700 health care experts from around the world assembled for the annual meeting of the International Continence Society, ICS, in Heidelberg, Germany, on August 28-30, 2002. Each year  the Continence Promotion Committee (CPC) of the ICS holds a workshop.  

This year the theme was around the role of general practitioners in the assessment and management of incontinence. "Our Committee realise this is a very important topic and we had put together a program from a number of different member countries to look at how they are addressing issues related to general practitioners (family physicians) in their assessment and management of incontinence." says David Fonda.

The workshop had presenters from 6 countries that discussed current approaches to promoting Continence Care to Primary Care Physicians/General Practitioners.  What was evident from the presentations was that there has been tremendous growth as well as unique approaches by private organizations worldwide that promote Continence. 

David Fonda announced that there are 25 countries that have national organizations that are attempting to either promote Continence to the lay public and/or health care professionals.  The ICS CPC has been instrumental in attempting to organize these groups in order to provide a framework for sharing of information and ideas.  The Continence Worldwide Newsletter was distributed at this meeting, as well as presentation of the growth of the CPC website which will now be accessed through ICS homepage.  There continues to be interest in the CPC providing aids on appliances information and information tools.  The year 2003 will mark the 10th anniversary of the Continence Promotion Committee and events are being planned to be held at the ICS Florence meeting.


Overview the International Consultation on Incontinence, ICI,
Promotion, Organization and Education for Continence Care Committee, 
by Diane Newman

The recommendations of this committee in the areas of promotion of continence awareness, education (both professional and lay public) and current organizations were presented.  Communicating to both professional and consumers is extremely important but it is felt that it is essential to use terms, which the public/patient understands (e.g. overactive bladder versus incontinence). Marketing is essential in communication and “Direct to Consumer Advertising” using TV appears to be effective for reaching large audiences.  Continence promotion in the past has emphasized illness and there is a need to need to refocus on “Bladder Health”.  Professional education on Continence is lacking throughout the world as it remains only a small part of education of most professionals (doctors, nurses, therapists).  Therefore, there is very little data on whether education can be effective in increasing awareness of identification and assessment of incontinence.  General practitioners need to be educated and know when and how to refer patients.  However, we do not know if the professional or public should be educated first.  The International Consultation on Incontinence, ICI Committee laid out clear recommendations in this area.  They felt that there should be compulsory education of all professionals with the teaching of incontinence as a separate topic in the curriculum.  Countries need to develop specialist education programs.  There is a need for research on translation of education and research into improved clinical practice and mechanisms for increasing professional motivation to acquire education and improve performance.

Diane Newman's presentation » slides PDF


Perception of Family Physicians on Incontinence and its Management in Singapore, by Peter Lim

There appears to be a perception that urinary incontinence and toileting is “dirty” in many Asian countries.  Singapore conducted a nationwide survey of general practitioners and found that a large percentage were interested in managing UI but 22% were not interested in treating patients.  There is a UI prevalence of 12.2% in the Pacific Region.  Survey drew responses from Chinese (90%), Indian (5%) and Malay (4%) doctors.  Over 61% of family doctors noted they have patients with incontinence with most being females.  This survey concluded that family physicians in Singapore expressed interest in learning how to treat incontinence.  The role of the gynecologist can be further expanded. The role of urodynamics and pelvic floor exercises must be emphasized to the medical community and facilities made available to the primary care team. 

Peter Lim's presentation » slides PDF


The National Continence Management Strategy (NCMS) in Australia, by David Fonda

The Continence Foundation has been able to make great strides in addressing continence promotion to both professionals and consumers through government funding of a large country wide initiative called the “National Continence Management Strategy (NCMS)”.  The organization created an expert advisory committee who went to the public to see what services were wanted and needed.  The committee developed a “National Continence Helpline” for use by professionals and consumers.  One of the requests was a national “public toilet map” which would detail all public bathrooms noting their location, fee and time they are available.  This information is available on a website so the public can access location prior to travel.  It appears as though this is a very unique and popular service.  Directories of Continence Products and Services have also been developed.   A multidisciplinary approach has been developed targeting practitioners such as pharmacists to educate them on the need to increase community awareness.  Dr Fonda also indicated that leaflets and brochures on, bladder and bowel related issues have been prepared on 14 subjects in 15 languages. These can be downloaded from the National Continence Strategy Management Website at www.continence.health.gov.au as well as other useful information regarding projects and strategies happening in Australia.

David Fonda's presentation » slides PDF


Austrian Incontinence Help Society, by Helmut Madersbacher

In Austria, general practitioners have a poor understanding of incontinence and because of time do not address UI in their practice. There is an attitude of  “Don’t Ask/Don’t Tell”.  The Society has attempted to have evening meetings with GPs to educate them about UI and to encourage them to assess for the problem in their patients.  In order to promote this assessment an “Incontinence Tool Box” was developed for GP’s that includes basic information, videos and a urine container.  Professor Madersbacher showed the contents of this box.  It evidently has been positively received.  GPs have voiced that they need guidance from urologic and gynecologic associations. 

Helmut Madersbacher's presentation » slides PDF 



Belgium Experience, by Els Bakker

Patients, caregivers, and industry founded an interest group called “UCONTROL” to coordinate activities. The goal was to support and coordinate actions by government authorities.  UCONTROL includes a permanent telephone line, information leaflets and posters for waiting rooms and hospitals. A survey of the public indicated that 75% of patients who consulted a GP felt that they received inadequate information.  So a scientific organization was formed to provide communication, quality control and continuous post- academic education for the different professionals (e.g. physical therapists and nurses) who provide incontinence services. 

Els Bakker's presentattion  » slides PDF



The U.S. National Association for Continence (NAFC), by Nancy Mueller

The US based NAFC is celebrating its 20th anniversary.  NAFC is a consumer advocacy group that uses a variety of marketing techniques for both professional and consumer audiences.  They receive funding from multiple sources.  Over the last 10 years, NAFC has performed multiple surveys of it members on UI and on specific topics such as SUI and OAB.  Members report dissatisfaction with UI care and feel that the approach to UI is poor because of a healthcare delivery system that is fragmented.  GPs and primary care doctors are not aware of current UI treatments and do not view the condition as an important medical problem.  NAFC has attempted to provide seminars to both professionals and consumers.  To raise awareness of UI as a chronic medical condition that needs attention, NAFC has created  “Continence Care Champion Awards” that are given to doctors, nurses and physical therapists that are leaders in the field. 

Nancy Müller's presentation » slides PDF   

 

Text Diane Newman