英国候诊室中的女性尿失禁的程度和严重性The extent and severity of urinary incontinence amongst women in UK GP waiting ro
10-31, 2015
引言。很少有女性会因为尿失禁的寻求帮助。之后,也可能许多女性只是去访问些初级保健服务机构寻求治疗或建议。如果较多的人群未表现出这种需要的话，一个更积极的自制管理方法可能更加合适,但是这个可行性取决于准确评估需求人群的数目。
目的。评估在初级护理治疗的程度上的女性尿失禁的发病率
方法。一份在西约克郡,伦敦、格拉斯哥和莱斯特参加初级护理实践时做的成年女性尿失禁的横断面的10至15天调查
结果。调查中共有三千二百七十三名(占54%)妇女给出回答。在先前的一个月内， 21%的人表示只会有压力性尿失禁。3.5%的人仅有急迫性尿失禁，21%的人会同时有压力性和急迫性尿失禁(9%的人却有中度或重度症状)。
introduction. Few women seek help for urinary incontinence. Subsequently, there may be many women accessing primary care services who would benefit from treatment or advice. If high levels of unexpressed need are present in this population, a more proactive approach to continence management may be appropriate, but the feasibility of this depends on an accurate assessment of the level of unmet need in this population.
Aim. To assess the prevalence of urinary incontinence in a female population attending primary care and the extent of treatment seeking in relation to level of need.
Methods. A cross-sectional survey of urinary incontinence of adult women attending primary care practices in West Yorkshire, London, Glasgow and Leicestershire during a 10- or 15-day period.
Results. Three thousand two hundred and seventy-three (54%) women responded. Twenty-one percent reported stress urinary incontinence only, 3.5% reported urge incontinence only and 21% reported mixed stress and urge incontinence during the preceding month (9% had moderate or severe symptoms). Fifty-three per cent of these had not consulted a health care professional, which is equivalent to 1 in 20 of women in GP waiting rooms, most of whom have stress and urge incontinence (75%) or stress incontinence only (21%).
Conclusions. Nearly half of female primary care attendees had experienced incontinence during the preceding month, but only a minority had sought help. Even amongst the nearly 1 in 10 women with moderate or severe incontinence only about half had sought help. There remains considerable health decrement due to urinary incontinence in those not receiving help in a population readily accessible to primary care services.
Introduction引言
Urinary incontinence is a common problem in adult women, with the prevalence in European countries reported to be around 35%.1 Stress urinary incontinence (SUI), resulting from an increase in intra-abdominal pressure in the presence of weak pelvic floor muscles, is most common (37%) and urge urinary incontinence (UUI) or sudden uncontrolled contractions of the detrus or the least common (20%), with a presentation of mixed stress and urge incontinence (MUI) being of intermediate prevalence (33%).1Estimates, however, vary owing to differences in sampling, definitions and procedures.
Although urinary incontinence and related symptoms can have substantial impact on quality of life, relatively few women seek help from health care professionals, leading to high levels of unmet need for incontinence services.3 This is mainly due to misattributions of cause such as assumptions that symptoms are normal after childbirth or in older age, and to a lack of awareness of available treatment options.4 It has been suggested that primary care professionals are in a position to take a more proactive approach to incontinence treatment by screening for urinary symptoms in at-risk groups, such as the elderly, during routine appointments.5 Before practices develop services in this way, it is important to assess the resource implications by estimating the level of need within the target population of primary care attendees. Pre-valence of urinary symptoms is likely to be higher in those accessing primary care services than prevalence estimates of conventional epidemiological studies would suggest, as there are high levels of co-morbidity in those with urinary symptoms.6 However, help seeking and thus met need may also be higher in those already in contact with services, and so it is important to establish the prevalence of symptoms and also of current levels of help-seeking and treatment provision to gain a more accurate reflection of unmet need for continence care within routine primary care practice.
A successful case-finding approach to addressing high levels of unmet need would also rely on practitioners being equipped to provide appropriate treatment. However, the available evidence suggests that treatment provision in primary care is variable. Many GPs have received limited training on incontinence issues and have poor awareness of treatment options and services, with the result that some women who do seek help receive no treatment or advice.7,8,4 In addition, case finding in primary care would ultimately impact on secondary care services, but there is little systematic evidence concerning preferred treatment pathways on which to base estimates of the likely secondary-care resource implications.
This study aims to provide information that would inform the feasibility of a case-finding approach to continence care by identifying the extent of unmet need for incontinence care in a primary care population. More specifically, the study examines the prevalence of urinary symptoms in women who are accessing primary care services and identifies the level of help-seeking for urinary symptoms in this population, and the treatments received. The study explores the characteristics of incontinence in terms of the prevalence of different types of incontinence, and patient perceptions of severity and impact on quality of life. These factors influence women’s decisions to seek help and so are important indicators of need. This information is ,therefore, useful in a clinical situation in identifying those who are most likely to require services. An understanding of treatment provision illustrates how well services are currently meeting the needs of those seeking help.
Methods方法
The sample was recruited from women attending primary care practices for services during a period of either 10 or 15 clinic days, depending on recruitment location. Four locations were selected to cover a wide range of geographical and cultural variation within the English-speaking population and within the organization of health care provision. These included West Yorkshire, London, Glasgow and Leicestershire. In order to ensure a sizeable sampling frame, participating practices were required to have at least four primary care physicians and to serve a female population of about 4000. Multiple primary care clinics agreed to take part in the study (eight in West Yorkshire, seven in London, five in Glasgow and two in Leicestershire).
Data were collected over 15 clinic days in Leicestershire and two practices in London and West Yorkshire. Data were collected over 10 clinic days in all other practices.
Results Response结果回顾
Seven thousand one hundred and fifty-one women were approached to take part, of whom 1087 were ineligible, giving an eligible sample of 6064. Three thousand two hundred and seventy-three (54%) agreed to complete a questionnaire (Fig. 1). The age group distribution of responders is shown in Table 1. A total of 61.8% of the sample lived in owned or mortgaged accommodation, 35.9% in rented, 0.5% in sheltered accommodation or residential care and 1.8% in other. The majority of the sample reported good or very good health (69%), with 10.6% reporting excellent health and 20.4% reporting fair or poor health.
Prevalence患病率
Table shows the prevalence during the preceding month by age group in the different categories of symptoms. Overall, 45.7% reported urinary incontinence, with 21.5% having SUI, 3.5% having UUI and 20.7% having MUI.
The prevalence of SUI peaked in the 30- to 49-year age group (24.7%) whilst the prevalence of MUI peaked in the 50- to 59-year age group (31.9%). UUI, however, remained fairly constant across the age range, with an increase in the oldest group, although sample size in this group is small.
There was a statistically significant difference between the groups in severity of incontinence (x2 =132.6, P < 0.001),which was a result of women with MUI reporting more severe incontinence than those with SUI or UUI. The majority of women with SUI (74.3%) and UUI (77.8%) reported monthly leakage, whereas the majority of women with MUI (59%) reported weekly or daily leakage. Combining all types of incontinence, 57.2% had monthly leakage or less often, 21.6% had weekly leakage and 21.2% had daily leakage (Fig. 2).
Self-perceived severity was also significantly different between the groups (x2 = 88.6, P < 0.001), which resulted from a significant difference between all possible pairings (all P < 0.05) except for MUI and UUI.
目的。评估在初级护理治疗的程度上的女性尿失禁的发病率
方法。一份在西约克郡,伦敦、格拉斯哥和莱斯特参加初级护理实践时做的成年女性尿失禁的横断面的10至15天调查
结果。调查中共有三千二百七十三名(占54%)妇女给出回答。在先前的一个月内， 21%的人表示只会有压力性尿失禁。3.5%的人仅有急迫性尿失禁，21%的人会同时有压力性和急迫性尿失禁(9%的人却有中度或重度症状)。
introduction. Few women seek help for urinary incontinence. Subsequently, there may be many women accessing primary care services who would benefit from treatment or advice. If high levels of unexpressed need are present in this population, a more proactive approach to continence management may be appropriate, but the feasibility of this depends on an accurate assessment of the level of unmet need in this population.
Aim. To assess the prevalence of urinary incontinence in a female population attending primary care and the extent of treatment seeking in relation to level of need.
Methods. A cross-sectional survey of urinary incontinence of adult women attending primary care practices in West Yorkshire, London, Glasgow and Leicestershire during a 10- or 15-day period.
Results. Three thousand two hundred and seventy-three (54%) women responded. Twenty-one percent reported stress urinary incontinence only, 3.5% reported urge incontinence only and 21% reported mixed stress and urge incontinence during the preceding month (9% had moderate or severe symptoms). Fifty-three per cent of these had not consulted a health care professional, which is equivalent to 1 in 20 of women in GP waiting rooms, most of whom have stress and urge incontinence (75%) or stress incontinence only (21%).
Conclusions. Nearly half of female primary care attendees had experienced incontinence during the preceding month, but only a minority had sought help. Even amongst the nearly 1 in 10 women with moderate or severe incontinence only about half had sought help. There remains considerable health decrement due to urinary incontinence in those not receiving help in a population readily accessible to primary care services.
Introduction引言
Urinary incontinence is a common problem in adult women, with the prevalence in European countries reported to be around 35%.1 Stress urinary incontinence (SUI), resulting from an increase in intra-abdominal pressure in the presence of weak pelvic floor muscles, is most common (37%) and urge urinary incontinence (UUI) or sudden uncontrolled contractions of the detrus or the least common (20%), with a presentation of mixed stress and urge incontinence (MUI) being of intermediate prevalence (33%).1Estimates, however, vary owing to differences in sampling, definitions and procedures.
Although urinary incontinence and related symptoms can have substantial impact on quality of life, relatively few women seek help from health care professionals, leading to high levels of unmet need for incontinence services.3 This is mainly due to misattributions of cause such as assumptions that symptoms are normal after childbirth or in older age, and to a lack of awareness of available treatment options.4 It has been suggested that primary care professionals are in a position to take a more proactive approach to incontinence treatment by screening for urinary symptoms in at-risk groups, such as the elderly, during routine appointments.5 Before practices develop services in this way, it is important to assess the resource implications by estimating the level of need within the target population of primary care attendees. Pre-valence of urinary symptoms is likely to be higher in those accessing primary care services than prevalence estimates of conventional epidemiological studies would suggest, as there are high levels of co-morbidity in those with urinary symptoms.6 However, help seeking and thus met need may also be higher in those already in contact with services, and so it is important to establish the prevalence of symptoms and also of current levels of help-seeking and treatment provision to gain a more accurate reflection of unmet need for continence care within routine primary care practice.
A successful case-finding approach to addressing high levels of unmet need would also rely on practitioners being equipped to provide appropriate treatment. However, the available evidence suggests that treatment provision in primary care is variable. Many GPs have received limited training on incontinence issues and have poor awareness of treatment options and services, with the result that some women who do seek help receive no treatment or advice.7,8,4 In addition, case finding in primary care would ultimately impact on secondary care services, but there is little systematic evidence concerning preferred treatment pathways on which to base estimates of the likely secondary-care resource implications.
This study aims to provide information that would inform the feasibility of a case-finding approach to continence care by identifying the extent of unmet need for incontinence care in a primary care population. More specifically, the study examines the prevalence of urinary symptoms in women who are accessing primary care services and identifies the level of help-seeking for urinary symptoms in this population, and the treatments received. The study explores the characteristics of incontinence in terms of the prevalence of different types of incontinence, and patient perceptions of severity and impact on quality of life. These factors influence women’s decisions to seek help and so are important indicators of need. This information is ,therefore, useful in a clinical situation in identifying those who are most likely to require services. An understanding of treatment provision illustrates how well services are currently meeting the needs of those seeking help.
Methods方法
The sample was recruited from women attending primary care practices for services during a period of either 10 or 15 clinic days, depending on recruitment location. Four locations were selected to cover a wide range of geographical and cultural variation within the English-speaking population and within the organization of health care provision. These included West Yorkshire, London, Glasgow and Leicestershire. In order to ensure a sizeable sampling frame, participating practices were required to have at least four primary care physicians and to serve a female population of about 4000. Multiple primary care clinics agreed to take part in the study (eight in West Yorkshire, seven in London, five in Glasgow and two in Leicestershire).
Data were collected over 15 clinic days in Leicestershire and two practices in London and West Yorkshire. Data were collected over 10 clinic days in all other practices.
Results Response结果回顾
Seven thousand one hundred and fifty-one women were approached to take part, of whom 1087 were ineligible, giving an eligible sample of 6064. Three thousand two hundred and seventy-three (54%) agreed to complete a questionnaire (Fig. 1). The age group distribution of responders is shown in Table 1. A total of 61.8% of the sample lived in owned or mortgaged accommodation, 35.9% in rented, 0.5% in sheltered accommodation or residential care and 1.8% in other. The majority of the sample reported good or very good health (69%), with 10.6% reporting excellent health and 20.4% reporting fair or poor health.
Prevalence患病率
Table shows the prevalence during the preceding month by age group in the different categories of symptoms. Overall, 45.7% reported urinary incontinence, with 21.5% having SUI, 3.5% having UUI and 20.7% having MUI.
The prevalence of SUI peaked in the 30- to 49-year age group (24.7%) whilst the prevalence of MUI peaked in the 50- to 59-year age group (31.9%). UUI, however, remained fairly constant across the age range, with an increase in the oldest group, although sample size in this group is small.
There was a statistically significant difference between the groups in severity of incontinence (x2 =132.6, P < 0.001),which was a result of women with MUI reporting more severe incontinence than those with SUI or UUI. The majority of women with SUI (74.3%) and UUI (77.8%) reported monthly leakage, whereas the majority of women with MUI (59%) reported weekly or daily leakage. Combining all types of incontinence, 57.2% had monthly leakage or less often, 21.6% had weekly leakage and 21.2% had daily leakage (Fig. 2).
Self-perceived severity was also significantly different between the groups (x2 = 88.6, P < 0.001), which resulted from a significant difference between all possible pairings (all P < 0.05) except for MUI and UUI.