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Abstract
Objective
To investigate how GPs manage women with urinary incontinence (UI) in the Netherlands and to assess whether this is in line with the relevant Dutch GP guideline. Because UI has been an underreported and undertreated problem for decades despite appropriate guidelines being created for general practitioners (GPs).
Design
Retrospective cohort study.
Setting
Routine primary care data for 2017 in the Netherlands.
Subjects
We included the primary care records of women aged 18–75 years with at least one contact registered for UI, and then extracted information about baseline characteristics, diagnosis, treatment, and referral to pelvic physiotherapy or secondary care.
Results
In total, 374 records were included for women aged 50.3 ± 15.1 years. GPs diagnosed 31.0%, 15.2%, and 15.0% women with stress, urgency, or mixed UI, respectively; no diagnosis of type was recorded in 40.4% of women. Urinalysis was the most frequently used diagnostic test (42.5%). Education was the most common treatment, offered by 17.9% of GPs; however, no treatment or referral was reported in 15.8% of cases. As many as 28.7% and 21.7% of women were referred to pelvic physiotherapy and secondary care, respectively.
Conclusion
Female UI is most probably not managed in line with the relevant Dutch GP guideline. It is also notable that Dutch GPs often fail to report the type of UI, to use available diagnostic approaches, and to provide appropriate education. Moreover, GPs referred to specialists too often, especially for the management of urgency UI.
Urinary incontinence (UI) has been an underreported and undertreated problem for decades. Despite various guidelines, UI often lies outside the GPs comfort zone.
•According to this study: general practitioners do not treat urinary incontinence according to guidelines.
•The type of incontinence is frequently not reported and diagnostic approaches are not fully used.
•We believe that increased awareness will help improve treatment and avoidable suffering.
Key points
Acknowledgements
We thank all GPs who participated in the included networks and shared their electronic health record data, the data managers Nicole Boekema and Hanna Joosten, and the teams of the participating networks for their assistance with the data extraction and linkage procedures. Finally, we thank Dr Robert Sykes (www.doctored.org.uk) for providing editorial services.
Ethical approval
The Medical Ethics Review Committee of University Medical Centre Groningen confirmed that the Medical Research Involving Human Subjects Act (WMO) does not apply to our study. This law takes the requirements of the Declaration of Helsinki into account.
Disclosure statement
The authors report no conflict of interests. The view and opinions expressed in the study are those of the individual authors and should not be attributed to the National Health Care Institute of the Netherlands.