A qualitative study of the assessment and treatment of incontinence in primary care.

BACKGROUND: Although incontinence is a common condition, previous studies have suggested that access to appropriate treatment is variable. Recent guidelines recommend initial conservative treatment in primary care and this study explores GPs management practices and the feasibility of applying guidelines.
OBJECTIVES: To describe the assessment and management practices of incontinence by GPs in primary care.
METHODS: Semi-structured interviews were carried out with 32 GPs practicing in South East Wales. Sampling was purposive to include a range of characteristics such as gender, age and size and location of practice. Interviews were audio taped and transcribed and a thematic analysis carried out using a grounded theory approach.
RESULTS: The extent to which GPs felt adequately informed to carry out assessment and treatment of incontinence was varied. While most were aware of appropriate assessment and investigation, none felt in a position to undertake conservative treatments such as bladder training or to monitor pelvic floor therapy either due to lack of knowledge or organizational constraints. Access to specialist continence services was also variable across different localities with many GPs being unaware of the remit of specialist nurses. However, there was a high rate of referral to secondary care which will result in high cost to the National Health Service.
CONCLUSIONS: There are a number of barriers to provision of first-line treatments in primary care, including variability in training and knowledge of GPs, as well as practical barriers (such as time resource) to carrying out assessments and treatment in routine surgeries. This results in increased likelihood of referral to secondary care.