1. |
- Sykes, D, et al.
(författare)
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Characteristics of female outpatients with urinary incontinence participating in a 6-month observational study in 14 European countries
- 2005
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Ingår i: Maturitas. - : Elsevier BV. - 1873-4111 .- 0378-5122. ; 52:Suppl 2, s. 13-23
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To describe the characteristics, of women seeking treatment for Symptoms of urinary incontinence (UI) in European countries. Design: Prospective urinary incontinence research (PURE) was a 6-month, observational, pan-European Study, primarily aimed at determining the direct costs of urinary incontinence treatment. The secondary objectives of PURE were to describe the impact of UI on health-related quality of life (HRQoL) in treatment seeking patients and to illustrate the treatment patterns For UI in Europe. Setting: One thousand and Fifty-five physicians from 14 European Countries, including general practitioners (GPs), gynaecologists, urologists and geriatricians, observed women seeking treatment For their UI and recorded data at the first observation and then prospectively at 3 and 6 months after the first observation during the normal course of therapy. Subjects: Women of at least 18 years of age who had experienced urinary leakage in the 12 months prior to enrolment in the study, who were seeking treatment or under treatment for UI and who presented within the normal,11 Course of UI care were included in the 6 months study. The first observation characteristics of the patients are described here. Methods: Demographic characteristics, as well as disease and treatment status at first observation were explored using descriptive summary statistics to gain an understanding Of the Population studied. Results: In total, 9487 women took part in PURE, with the largest patient groups from Germany, Spain and the UK/Ireland. The majority of women were post-menopausal and had a mean age of 60.7 years, were not current smokers and tended to be overweight (BMI > 25.0). Overall, mixed UI symptoms were more common than SUI and UUI as defined by clinical opinion (SUI 38%, MUI 42% and UUI 18%), and by a two-item questionnaire, the S/UIQ (SUI 29%. MUI 58% and UUI 13%). Around half of the patients (48%) suffered from their symptoms for less than 2 years before consulting a physician; 28% delayed seeking treatment for 3-5 years, with 13% waiting for 6-10 years and the remaining 11% waiting for 11 or more years. Conclusions: Some of the described patients' characteristics may provide important information to clinicians to enable them to take a more active approach to case-finding, which Will ultimately benefit the incontinent patient.
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2. |
- Monz, B, et al.
(författare)
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A description of health care provision and access to treatment for women with urinary incontinence in Europe - A five-country comparison
- 2005
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Ingår i: Maturitas. - : Elsevier BV. - 1873-4111 .- 0378-5122. ; 52:Suppl 2, s. 3-12
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Tidskriftsartikel (refereegranskat)abstract
- Background: Female urinary incontinence is a prevalent condition, but only about one-third of women seek treatment. Objectives: To describe the health care provision for women with urinary incontinence from a European perspective, selecting France, Germany, Spain, Sweden, and the United Kingdom as examples, and to investigate whether specific barriers for treatment exist. Methods: Available health care system information, a literature review and clinical expert information identified patterns of treatment provision. Results: In Spain, Sweden, and the UK, access to medical care in general is primarily through the general practitioners. However, in Spain and Sweden, women with urinary incontinence can directly visit specialists. In France and Germany, women have equal access to either general practitioners or specialists. Aside from general practitioners. gynaecologists play a major role ill urinary incontinence care in all countries except the UK. In Germany, urologists are also involved in initial female urinary incontinence cared however, only in about 16% of women. There are no waiting lists in France and Germany for appointments with physicians or procedures, contrary to Spain, which has long waiting lists. Access to general practitioners in the UK is unrestricted whereas advanced diagnosis and treatment in secondary care requires long waits. A specific Swedish policy mandates that no woman is required to wait longer than,3 months for incontinence visits and related surgery. In Sweden and the UK, specialist nurses and other health care workers provide incontinence set-vices. Almost all treatment options for urinary incontinence are at least in part reimbursed. However, various co-payments and fees in France, Germany, Spain and Sweden exist and constitute out-of-pocket expenses for women if no complementary additional private health insurance is available. In some countries, financial incentives for physicians to provide incontinence services are low, raising concerns about their interest to engage in continued patient care. Conclusions: Information about service provision in Europe for women with urinary incontinence is limited and makes it difficult to understand barriers to treatment seeking. A broad European perspective may promote optimised treatment access in the future for this widespread and under-recognised condition.
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3. |
- Monz, B, et al.
(författare)
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Patient-reported impact of urinary incontinence - Results from treatment seeking women in 14 European countries
- 2005
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Ingår i: Maturitas. - : Elsevier BV. - 1873-4111 .- 0378-5122. ; 52:Suppl 2, s. 24-34
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To describe the patient-reported impact of urinary incontinence (UI) in treatment-seeking women in Europe. Design: PURE was a non-interventional, observational study, which aimed to describe the direct costs of treatment for European women seeking treatment for UI. A secondary Study objective was to describe the impact of UI on health-related quality of life (HRQoL) by UI subtype and severity of disease. This paper presents the results from quality of life assessments as well as bothersomeness and interference with daily activities from the first study observation. Subjects: Nine thousand four hundred and eighty-seven European women who had UI symptoms in the last 12 months were enrolled. Their UI symptoms were frequently those defined as mixed urinary incontinence (MUI) and were moderate to severe in nature. Measurements: HRQoL was assessed at the first observation using the urinary Incontinence-specific Quality of Life Questionnaire (I-QOL) and the EQ-5D, a generic quality of life questionnaire. Data collected from EQ-5D provided insight into the patients' general health perception, while the I-QOL data indicated how affected the women were about their UI symptoms. Higher EQ-5D and I-QOL scores represent better quality of life. Patients were asked to indicate how much UI symptoms limited selected activities and to indicate the degree to which they found their symptoms to be bothersome. Results: Overall, the median self-rated health status on the EQ-5D visual analogue scale (VAS) was 70.0 and the median EQ-5D health state index was 0.85, with small but noticeable differences observed between countries. Of the five health dimensions of the EQ-5D, patients' self-care appeared to be the least affected by UI, with fewer than 10% of the women reporting that they had some problems. Between 20 and 40% of patients had some problems with their mobility and usual activities, or had pain/discomfort or anxiety/depression. However, the impact of existing co-morbidity was not assessed and may have affected some women's scoring of the EQ-5D domains. The mean total I-QOL score overall was 57.7 and of the three subscales of the I-QOL, psychosocial impact had the highest overall scores, representing fewer problems, with lower scores observed for the avoidance and limiting behaviour subscale, and even lower scores for the social embarrassment subscale. The greatest patient-reported impact of UI symptoms on activities was on exercise, with more than 45% of patients moderately to totally limited in this activity. In most of the countries, more than 60% of the women reported that they were moderately to extremely bothered by their UI symptoms. Conclusions: There was considerable impact of UI on HRQoL in a treatment seeking population, as demonstrated by the disease-specific quality of life scale and by the high percentage of patients who were bothered by their symptoms.
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