Authors (including presenting author) :
Siu YS(1), Wong TT(1), Tsang SM(1), Lui BKP(1), Chan TS(1), Ho SKS(1), Pang HSI(1), Tao YCK(2), Yip NJ(2), Ma W(2), Lo YK(2), Kwong SFS(2), Lam CY(1), Wong CW(1), Wan MC(1)
Affiliation :
(1)Department of Medicine and Geriatrics, Ruttonjee & Tang Shiu Kin Hospitals, (2)Physiotherapy Department, Ruttonjee & Tang Shiu Kin Hospitals
Introduction :
Urinary incontinence (UI) is troubling 28% of older adults and over 50% of females in primary care setting. Joint management by Specialist doctors, Continence nurse and Physiotherapist (PT) to provide coordinated interventions is crucial to improve clinical outcomes. However, in Ruttonjee Hospital (RH) Geriatric Continence Care clinic (GCCC), questionnaires to report lifestyle behaviors or quantified level of bother was not available to aid diagnosis. Moreover, patient empowerment with lifestyle modification (LSM) advice by nurses only covered two-third of the patients; and pelvic floor muscle exercise (PFE) training by PT in out-patient setting required a waiting time of 3 to 4 months. A reform of the clinic structure and operation has hence taken place to improve service quality and timeliness of service delivery.
Objectives :
1. Improve service quality by strengthening Continence service coordination and collaboration in multi-disciplinary approach;
2. Enhance service delivery to out-patients through the provision of one-stop service in Integrated Continence Clinic
Methodology :
A Continence team consisting of Geriatricians and Continence Nurses was formed and clinic workflow was reviewed and endorsed. In September 2019, an Integrated Continence Clinic (ICC) to provide one-stop, multi-disciplinary team (MDT) service by doctor, nurse and PT launched service in RH Geriatric Day Hospital (GDH). At each attendance: 1. Patients were assessed by Continence Nurse for lifestyle behaviors and level of bother with the validated questionnaire, "International Consultation on Incontinence Questionnaire - Urinary Incontinence" (ICIQ-UI). 2. Geriatrician assessed the patients, reviewed ICIQ-UI scores and lifestyle behaviors. 3. Continence Nurse provided LSM and symptom management advice and other supportive care. 4. Patients were given PFE training by on-site PT as first-line treatment or Electromagnetic chair treatment as adjuvant therapy, during the same or next ICC visit.
Result & Outcome :
Operational data before and after service launch and ICIQ-UI scores of 197 patients attended in ICC from September 2019 to December 2024 were analyzed. 1. Higher Continence Nurse coverage: At ICC, patients assessed and given LSM advice by Continence Nurse rose from 65% to 99%. 2. Faster Physiotherapist input: One-stop PT service was provided to around 48% of ICC patients, of which 30% were seen on-site without additional travelling. On average, the waiting time for PT lowered by 86%, from 3.5 months to 2 weeks. 3. Better Patient Outcome: Among 140 patients receiving only non-pharmacological treatments, their average ICIQ-UI scores lowered 25%, from 10.5 to 7.8 (p<0.01), reflecting a decreased level of bother. To conclude, the ICC, riding on GDH as a mature multi-disciplinary collaboration hub for ambulatory elderly services, has improved Continence service accessibility and benefited elderly patients, as recommended in HKEC Cluster Service Plan. Patients with UI received integrated, one-stop care by the MDT in ICC, which helped reduce their bother and uphold their rights to be continent.
