Health service provision for community-dwelling people suffering urinary incontinence: A case study of neglect.

Abstract

Access to health services for common health problems is a fundamental principle of primary health care. Although there have been few Australian prevalence studies, it is estimated that about 900,000 adult Australians suffer from incontinence (National Health and Medical Research Council, 1994). The purpose of this study was to investigate urinary continence services for community-dwelling people in the Gold Coast region of Australia, prior to implementing new services. A case study design was used, including: a survey of general medical practitioners, specialist medical practitioners, physiotherapists, hospitals, and home visiting agencies in the region; a focus group with key stakeholders; and a critical review of the literature in relation to prevalence, treatment-seeking behaviour and service provision. Health practitioners were asked about services provided, policies, clinical pathways, referrals, and their views on what services they would like to see offered in the region. Results showed that while there were some existing continence-specific services in the region, they were inadequate to provide for the numbers of people in need. Many generalist health practitioners demonstrated a lack of interest in and knowledge of the plight of those suffering from incontinence. Links between services were found to be ad hoc, with inconsistent referral patterns between health professionals. These findings are consistent with international studies. It was concluded that, in general, community-dwelling people suffering incontinence were poorly served by health professionals due an inability of available services to meet demand, and a lack of knowledge and/or interest by many generalist health practitioners.