at xxcxY LIBRAPY CALIP The Agency for Health Care Policy and Research (AHCPR) was established in December 1989 under Public Law 101-239 (Omnibus Budget Reconciliation Act of 1989) to enhance the quality, appropriateness, and effectiveness of health care services and access to these services. AHCPR carries out its mission through conduct and support of general health services research, including medical effectiveness research, facilitating development of clinical practice guidelines, and dissemination of research findings and guidelines to health care providers, policymakers, and the public. The legislation also established within AHCPR the Office of the Forum for Quality and Effectiveness in Health Care (the Forum). The Forum has primary responsibility for facilitating the development, periodic review, and updating of clinical practice guidelines. The guidelines will assist practitioners in the prevention, diagnosis, treatment, and management of clinical conditions. Other components of AHCPR include: the Center for Medical Effectiveness Research, which has principal responsibility for patient outcomes research and studies of variations in clinical practice; the Center for General Health Services Extramural Research, which supports research on primary care, the cost and financing of health care, and access to care for underserved and rural populations; the Center for General Health Services Intramural Research, which uses large data sets for policy research on national health care expenditures and utilization, hospital studies, and long-term care; the Center for Research Dissemination and Liaison, which produces and disseminates findings from AHCPR-supported research, including guidelines, and conducts research on dissemination methods; the Office of Health Technology Assessment, which responds to requests from Federal health programs for assessment of health care technologies; and the Office of Science and Data Development, which develops specialized data bases and enhances techniques for using existing data bases for patient outcomes research. Guidelines are available in formats suitable for health care practitioners, the scientific community, educators, and consumers. AHCPR invites comments and suggestions from users for consideration in development and updating of future guidelines. Please send written comments to Director, Office of the Forum, Executive Office Center, Suite 401, 2101 East Jefferson Street, Rockville, MD 20852. This document is in the public domain and may be used and reprinted without special permission, except for those copyrighted materials noted for which further reproduction is prohibited without the specific permission of copyright holders. AHCPR, will appreciate citation as to source, and the suggested format is provided below: Urinary Incontinence Guideline Panel. Urinary Incontinence in Adults: Urinary Incontinence in Adults March 1992 U.S. Department of Health and Human Services Agency for Health Care Policy and Research PUBLIC HEALTH Urinary Incontinence in Adults Guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical conditions. This guideline was developed by an independent, multidisciplinary panel of private sector clinicians and other experts convened by the Agency for Health Care Policy and Research (AHCPR). The panel employed an explicit, science-based methodology and expert clinical judgment to develop specific statements on patient assessment and management for the clinical condition selected. Extensive literature searches were conducted and critical reviews and syntheses were used to evaluate empirical evidence and significant outcomes. Peer review and field review were undertaken to evaluate the validity, reliability, and utility of the guideline in clinical practice. The panel's recommendations are primarily based on the published scientific literature. When the scientific literature was incomplete or inconsistent in a particular area, the recommendations reflect the professional judgment of panel members and consultants. In some instances, there was not unanimity of opinion. The guideline reflects the state of knowledge, current at the time of publication, on effective and appropriate care.' Given the inevitable changes in the state of scientific information and technology, periodic review, updating, and revision will be done. We believe that the AHCPR-assisted clinical guideline development process will make positive contributions to the quality of care in the United States. We encourage practitioners and patients to use the information provided in this clinical practice guideline. The recommendations may not be appropriate for use in all circumstances. Decisions to adopt any particular recommendation must be made by the practitioner in light of available resources and circumstances presented by individual patients. J. Jarrett Clinton, M.D. Administrator Agency for Health Care Policy and Research 'For a complete list of the literature surveyed, see the bibliography of Urinary Incontinence in Adults: Guideline Report (AHCPR Publication No. 92-0039). Rockville, MD: Agency for Health Care Policy and Research. In press. 10.2 PUBL Urinary Incontinence in 'Adults Foreword Urinary incontinence (UI) affects approximately 10 million Americans, mostly elderly, in community and institutional settings. Despite its prevalence, and an estimated annual cost of $10 billion, most affected individuals do not seek help for incontinence, primarily because of embarrassment or because they are not aware that help is available. When individuals do seek help, evidence exists that practitioners are hesitant to discuss the problem or do little to assess or treat it properly. A number of Federal and private organizations have provided research funding for the study of UI. Data from these studies indicate that treatment of UI is effective in most people, but there is an increased need for efforts to inform and educate the public and health care providers about the problem. Furthermore, evidence exists that there are wide variations in the actual costs and methods of providing care for UI, in the actual costs per procedure, and the charges within each diagnostic group. It is expected that UI will continue to be a significant health care problem in the elderly and institutionalized populations, and will, in fact, increase as the population of America continues to age. This clinical practice guideline adresses major evaluative, diagnostic, treatment, and management issues of UI. It was developed under the sponsorship of the Agency for Health Care Policy and Research (AHCPR), Public Health Service, U.S. Department of Health and Human Services. To develop the guideline, AHCPR convened an interdisciplinary, expert panel made up of physicians, nurses, gerontologists, other allied health professionals, and consumers. The panel first undertook an extensive and interdisciplinary clinical review of current needs, therapeutic practices and principles, and emerging technologies for diagnosis and treatment of UI. Second, the panel conducted a comprehensive review of the field to define the existing knowledge base and critically evaluate the assumptions and common wisdom in the field. Third, the panel initiated peer review of guideline drafts and field review with intended users in clinical sites. Comments from these reviews were assessed and used in developing the guideline. This is the first edition of the Clinical Practice Guideline on Urinary Incontinence in Adults. Further editions will be produced as needed to reflect new research findings and experience with emerging technologies for UI diagnosis and treatment. Acknowledgments The panel wishes to acknowledge several other consultants and technical advisers. They have provided external reviews for the combined analyses, consultation during panel meetings, and testimony during the open forum. They are: June Abbey, PhD, RN Alexandre Afanasyev, MD Dorothy Baker, PhD Margaret Bauman, MD Jerry Blaivas, MD Richard Bump, MD Kathryn Burgio, PhD Katrina Gahelko, PhD Simon Foundation and Presenters at the Open Forum: Maren Anderson Agnes Buchanan, RN Rebecca Chalker, MA Mikel Gray, PhD Peter Preziosi Dr. Rick Russell Kristy Wright, RN and the Contract Agencies of: Fu Associates, Inc. Health Systems Research, Inc. Moshman Associates, Inc. Joseph Salisz, MD Jack Shelton Henry Thiede, MD Diane Smith, RN, MSN, CRNP |