Primary Care and Access To Surgical Treatment For Women With Urinary Incontinence

Application Number
16_187
Lay Summary

Background: Urinary incontinence (UI) is the unintended leakage of urine during normal everyday activities. This common condition has a significant impact on a woman's well-being. While treatments (lifestyle changes and drugs) are offered in primary care, surgical care can be recommended if symptoms persist. There are concerns about the availability and quality of care for women with UI, especially surgical treatment. Information is lacking on: whether the rate of surgical procedures is appropriate or uniform across hospitals; whether access differs by age, ethnicity and socio-economic background; the factors that impact on women's treatment preferences; and how doctors decide whether to recommend surgery.

Purpose: To improve the delivery of surgical services for women with UI by: assessing the accuracy and completeness of data on UI in national primary and secondary care datasets; investigating the variation in care and surgical treatments across England; and exploring factors that determine whether patients are referred to secondary care and/or have surgery.

Potential Importance: The results will enable commissioners, managers and policy makers to improve care for women with UI.

Technical Summary

Background: Urinary incontinence (UI) affects one in three adult women, but fewer than 20% of them are actively treated, despite UI's wide-ranging impact on employment, social activities and personal relationships. Rates of surgery for UI have increased over the last decade, mostly due to new procedures, but there is evidence of inequity in access and service provision, with concerns of under-provision in vulnerable populations.

Aim: To improve the delivery of surgical care for women with UI.

Objectives: To assess the consistency, completeness and accuracy of data on UI in routine datasets. To examine variations in care, referral patterns and determinants of both.

Methods and Data Analysis: We will develop coding frameworks for UI and relevant treatments by assessing consistency, completeness and accuracy of diagnostic and treatment/procedure codes used in inpatient and outpatient Hospital Episodes Statistics (HES) and Clinical Practice Research Datalink (CPRD). Referral patterns and determinants of referral and surgery will be examined using a linked primary care (CPRD) and secondary care dataset (HES) and multiple regression models. Potential determinants include age, BMI, ethnicity, socio-economic deprivation and patterns of prior care.

Health Outcomes to be Measured

Treatments given in primary care Referral to a gynaecology outpatient clinic Surgical treatment

Collaborators

Jan van der Meulen - Chief Investigator - London School of Hygiene & Tropical Medicine ( LSHTM )
Rebecca Geary - Corresponding Applicant - London School of Hygiene & Tropical Medicine ( LSHTM )
Andrew Wilson - Collaborator - University of Leicester
David Cromwell - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Douglas G Tincello - Collaborator - University of Leicester
Ipek Gurol-Urganci - Collaborator - Imperial College London
Jil Billy Mamza - Collaborator - Astra Zeneca Ltd - UK Headquarters
Jonathan Duckett - Collaborator - Medway Primary Care Trust
Masao Iwagami - Collaborator - University of Tsukuba
Mylene Lagarde - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Philip Milton Toozs-Hobson - Collaborator - University Hospital Birmingham
Rebecca Lynch - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Simon Cohn - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Tahir Mahmood - Collaborator - Victoria Hospital, Kirkcaldy

Linkages

HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation