Treatment by a nurse practitioner in primary care improves the severity and impact of urinary incontinence in women. An observational study.

BACKGROUND: Urinary Incontinence (UI) is a common problem in women. The management of UI in primary care is time consuming and suboptimal. Shift of incontinence-care from General Practitioners (GP's) to a nurse practitioner maybe improves the quality of care. The purpose of this observational (pre/post) study is to determine the effectiveness of introducing a nurse practitioner in UI care and to explore women's reasons for not completing treatment. METHODS: Sixteen trained nurse practitioners treated female patients with UI. All patients were examined and referred by the GP to the nurse practitioner working in the same practice. At baseline the severity of the UI (Sandvik-score), the impact on the quality of life (IIQ) and the impressed severity (PGIS) was measured and repeated after three months Differences were tested by the paired t and the NcNemar test. Reasons for not completing treatment were documented by the nurse practitioner and differences between the group that completed treatment and the drop-out group were tested. RESULTS: We included 103 women, mean age 55 years (SD 12.6). The Sandvik severity categories improved significantly (P < 0.001), as did the impact on daily life (2.54 points, P = 0.012). Among the IIQ score the impact on daily activities increased 0.73 points (P = 0.032), on social functioning 0.60 points (P = 0.030) and on emotional well-being 0.63 points (P = 0.031). The PGIS-score improved in 41.3% of the patients. The most important reasons for not completing the treatment were lack of improvement of the UI and difficulties in performing the exercises. Women who withdraw from guidance by the nurse practitioner perceived more impact on daily life (P = 0.036), in particular on the scores for social functioning (P = 0.015) and emotional well-being (P = 0.015). CONCLUSION: Treatment by a trained nurse practitioner seems positively affects the severity of the UI and the impact on the quality of life. Women who did not complete treatment suffer from more impact on quality of life, experience not enough improvement and mention difficulties in performing exercises.

Help-seeking behaviour in primary care of men and women with a history of abuse: A Dutch cohort study.

BACKGROUND: Previous studies show an association between a history of abuse and higher care demand. However, studies in general practice regarding help-seeking behaviour by patients (mainly male patients) with a history of abuse are scarce. OBJECTIVES: To analyse help-seeking behaviour in general practice of men and women with a history of abuse. METHODS: A cohort study using data from a Dutch primary care registration network from 2015 to 2019. We included all patients aged ≥ 18 years who indicated on a questionnaire that they did or did not have a history of abuse. We analysed differences in contact frequency, types of contact, reason for encounter and diagnoses between men and women with or without a history of abuse. RESULTS: The questionnaire had a response rate of 59% and resulted in 11,140 patients, of which 1271 indicated a history of abuse. Men and women with a history of abuse contact the general practitioner (GP) 1.5 times (95% CI 1.42-1.60) more often than men and women without a history of abuse, especially for psychological (rate ratio 1.97, 95% CI 1.79-2.17) and social (rate ratio 1.93, 95% CI 1.68-2.22) problems. Moreover, when diagnosed with a psychological or social problem, patients with a history of abuse contact the GP twice more often for these problems. CONCLUSION: Compared to men and women without a history of abuse, men and women with a history of abuse visit their GP more often, particularly for psychological and social problems.

Effectiveness of involving a nurse specialist for patients with urinary incontinence in primary care: results of a pragmatic multicentre randomised controlled trial.

BACKGROUND: Urinary incontinence (UI) primary care management is substandard, offering care rather than cure despite the existence of guidelines that help to improve cure. Involving nurse specialists on incontinence in general practice could be a way to improve care for UI patients. AIMS: We studied whether involving nurse specialists on UI in general practice reduced severity and impact of UI. METHODS: Between 2005 and 2008 a pragmatic multicentre randomised controlled trial was performed comparing a 1-year intervention by trained nurse specialists with care-as-usual after initial diagnosis and assessment by general practitioners in adult patients with stress, urgency or mixed UI in four Dutch regions (Maastricht, Nijmegen, Helmond, The Hague). Simple randomisation was computer-generated with allocation concealment. Analysis was performed by intention-to-treat principles. Main outcome measure was the International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI SF) severity sum score. RESULTS: A total of 186 patients followed the intervention and 198 received care-as-usual. Patients in both study groups improved significantly in UI severity and impact on health-related quality of life. After correction for effect modifiers [type of UI, body mass index (BMI)], we found significant differences between groups in favour of the intervention group at 3 months (p = 0.04); no differences were found in the 1-year linear trend (p = 0.15). Patients in the intervention group without baseline anxiety/depression improved significantly better compared with care-as-usual after 1 year (p = 0.03). CONCLUSION: Involving nurse specialists in care for UI patients supplementary to general practitioners can improve severity and impact of UI, after correction for effect modifiers. This is also the case in specific situations such as anxiety/depression.

Experiences and attitudes of nurse specialists in primary care regarding their role in care for patients with urinary incontinence.

AIM: To explore experiences and attitudes of nurse specialists in primary care regarding their role in care for patients with urinary incontinence (UI), thereby identifying facilitators and barriers for wider implementation. BACKGROUND: Currently, primary care for patients with UI lacks sufficient adherence to existing guidelines on UI and is far from optimal. Studies in various countries show that involving nurse specialists may offer a solution to the inadequate care for UI. As qualitative studies on experiences of nurses with this type of intervention are lacking, we performed this study with a qualitative approach and data collection method within the course of a randomized controlled trial (RCT). METHOD: A focus group study was conducted in 2007 with six nurse specialists who were trained in caring for patients with UI in our pragmatic RCT. The focus group interview was audio-taped and transcribed verbatim. The data were analysed using qualitative content analysis to identify themes. To understand obstacles and incentives for change, we relied on an existing 'implementation model'. FINDINGS: Nurse specialists feel competent to provide advice and information, to offer possible solutions and to give attention and guidance to the process of care of people with UI. They feel appreciated by patients and feel they offer an added value to the usual care of general practitioners (GPs). Nurses sometimes notice that GPs lack interest in UI. Personal contact with the GPs, availability of enough time, adequate equipment and financial resources are important preconditions for effective nurse specialist care. Nurse specialists value continuous education and feedback in daily care for patients with UI. CONCLUSION: Trained nurse specialists appeared to feel competent and satisfied to support GPs in care for patients with UI. They feel highly appreciated by both patients and GPs.

[Subfertility in mentally disabled people who desire to have children: how to give balanced advice]. / Kinderwens van verstandelijk beperkte ouders met subfertiliteit.

When people with a mental disability fail to conceive naturally, they also like to be considered for fertility treatment. However, the GP, gynaecologist or fertility specialist may question their parenting competence. Physicians may and can refuse fertility treatment if they have reasons to suspect that the child will have a poor quality of life. We are using a case history to outline how a well-considered multidisciplinary recommendation can be made that does justice to the patient's request while causing the least amount of grief. The guiding principle in doing so is the moral consideration that the harm to the future child should not outweigh the harm to the parents.

Changes in the pattern of service utilisation and health problems of women, men and various age groups following a destructive disaster: a matched cohort study with a pre-disaster assessment.

OBJECTIVES: Female gender and young age are known risk factors for psychological morbidity after a disaster, but this conclusion is based on studies without a pre-disaster assessment. The aim of this study in family practice was to investigate if these supposed risk factors would still occur in a study design with a pre-disaster measurement. METHODS: A matched cohort study with pre-disaster (one year) and post-disaster (five years) data. Community controls (N = 3164) were matched with affected residents (N = 3164) on gender, age and socioeconomic status. Main outcome measures were utilization rates measured by family practice attendances and psychological, musculoskeletal and digestive health problems as registered by the family practitioner using the International Classification of Primary Care (ICPC). RESULTS: Affected residents of female and male gender and in five age groups all showed increases in utilization rates in the first post-disaster year and in psychological problems when compared to their pre-disaster baseline levels. The increases showed no statistically significant changes, however, between women and men and between all age groups. CONCLUSION: Gender and age did not appear to be disaster-related risk factors in this study in family practice with a pre-disaster base line assessment, a comparison group and using existing registries. Family practitioners should not focus specifically on these risk groups.

Gender sensitivity among general practitioners: results of a training programme.

BACKGROUND: Gender differences contribute to patients' health and illness. However in current healthcare practices attention to gender differences is still underdeveloped. Recognizing these differences and taking them into account can improve the quality of care. In this study we aimed to investigate whether GPs' gender sensitivity can be stimulated by a training programme. The focus was on three diseases: angina pectoris, depression and urinary incontinence. METHODS: This study had a quantitative, explorative and descriptive design. By means of a training programme 18 GPs were trained to focus on gender-sensitive recommendations for the three diseases. With standardised registration forms, data were collected during a 6-month period. During the registration period, the GPs were visited by the study team to discuss the process of data collection. RESULTS: The GPs filled in registration forms for 100 patients: 39 with angina pectoris (31 women and 8 men), 40 with depression (26 women and 14 men), and 21 with urinary incontinence (20 women and 1 man). The results show that gender sensitivity can be stimulated among trained professionals. The combination of the training programme, clear and practical recommendations, daily discussion of relevant cases between the GP couples, feedback and support during registration by the study team probably contributed to the outcome. CONCLUSION: GPs' gender sensitivity was stimulated by the training programme and the supporting visits. Ideally, structural attention could be realised by embedding gender issues in existing organisational structures of general practices.

Violent Female Offenders Compared With Violent Male Offenders on Psychological Determinants of Aggressive Behavior.

Psychological determinants of aggressive behavior (personality traits and problem behaviors) in 59 Dutch female offenders (outpatients and detainees) were compared with those in 170 male offenders (outpatients and detainees) who were all convicted of a violent crime. The violent female offenders scored significantly higher on neuroticism and trait anger, and significantly lower on hostility than the male offenders; however, effect sizes were small. A subgroup of female forensic psychiatric outpatients did not differ from a subgroup of male outpatients on all measures, whereas a subgroup of female detainees scored significantly higher on anger and aggression, but lower on hostility and psychopathy than did a subgroup of male detainees. These first results might indicate that violent female offenders do not differ much from violent male offenders regarding personality traits and problem behaviors. The differences between both groups of violent offenders were largely borne by the subgroup of violent female detainees compared with the subgroup of violent male detainees.

Bringing gender sensitivity into healthcare practice: a systematic review.

OBJECTIVE: Despite the body of literature on gender dimensions and disparities between the sexes in health, practical improvements will not be realized effectively as long as we lack an overview of the ways how to implement these ideas. This systematic review provides a content analysis of literature on the implementation of gender sensitivity in health care. METHODS: Literature was identified from CINAHL, PsycINFO, Medline, EBSCO and Cochrane (1998-2008) and the reference lists of relevant articles. The quality and relevance of 752 articles were assessed and finally 11 original studies were included. RESULTS: Our results demonstrate that the implementation of gender sensitivity includes tailoring opportunities and barriers related to the professional, organizational and the policy level. As gender disparities are embedded in healthcare, a multiple track approach to implement gender sensitivity is needed to change gendered healthcare systems. CONCLUSION: Conventional approaches, taking into account one barrier and/or opportunity, fail to prevent gender inequality in health care. For gender-sensitive health care we need to change systems and structures, but also to enhance understanding, raise awareness and develop skills among health professionals. PRACTICE IMPLICATIONS: To bring gender sensitivity into healthcare practice, interventions should address a range of factors.