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Cost-Effectiveness of Including a Nurse Specialist in the Treatment of Urinary Incontinence in Primary Care in the Netherlands

OBJECTIVE: 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 optim...

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Autores principales: 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.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4591337/
https://www.ncbi.nlm.nih.gov/pubmed/26426124
http://dx.doi.org/10.1371/journal.pone.0138225
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author 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.
author_facet 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.
author_sort Holtzer-Goor, K. M.
collection PubMed
description OBJECTIVE: 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. METHOD: 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. RESULTS: 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. CONCLUSION: 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.
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spelling pubmed-45913372015-10-09 Cost-Effectiveness of Including a Nurse Specialist in the Treatment of Urinary Incontinence in Primary Care in the Netherlands 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. PLoS One Research Article OBJECTIVE: 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. METHOD: 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. RESULTS: 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. CONCLUSION: 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. Public Library of Science 2015-10-01 /pmc/articles/PMC4591337/ /pubmed/26426124 http://dx.doi.org/10.1371/journal.pone.0138225 Text en © 2015 Holtzer-Goor et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
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.
Cost-Effectiveness of Including a Nurse Specialist in the Treatment of Urinary Incontinence in Primary Care in the Netherlands
title Cost-Effectiveness of Including a Nurse Specialist in the Treatment of Urinary Incontinence in Primary Care in the Netherlands
title_full Cost-Effectiveness of Including a Nurse Specialist in the Treatment of Urinary Incontinence in Primary Care in the Netherlands
title_fullStr Cost-Effectiveness of Including a Nurse Specialist in the Treatment of Urinary Incontinence in Primary Care in the Netherlands
title_full_unstemmed Cost-Effectiveness of Including a Nurse Specialist in the Treatment of Urinary Incontinence in Primary Care in the Netherlands
title_short Cost-Effectiveness of Including a Nurse Specialist in the Treatment of Urinary Incontinence in Primary Care in the Netherlands
title_sort cost-effectiveness of including a nurse specialist in the treatment of urinary incontinence in primary care in the netherlands
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4591337/
https://www.ncbi.nlm.nih.gov/pubmed/26426124
http://dx.doi.org/10.1371/journal.pone.0138225
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