NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Evidence review for treatment options for women using absorbent containment products
Evidence review B
NICE Guideline, No. 123
National Guideline Alliance (UK).
Treatment options for women using absorbent containment products
Review question
How often, by whom and how should alternative treatment options be reviewed for women who are using absorbent containment products?
Introduction
The aim of this review is to determine how often women using absorbent containment products should be reviewed for alternative treatment options. There is concern amongst stakeholders and the committee that many women are using containment products in the long term without opportunity for reassessment and that there is variation in the supply of absorbent containment products.
Summary of the protocol
See Table 1 for a summary of the Population, Intervention, Comparison and Outcome (PICO) characteristics of this review.
Table 1
Summary of protocol (PICO table).
For further details see review protocol in appendix A.
Methods and process
This evidence review was developed using the methods and process described in Developing NICE guidelines: the manual 2014. Methods specific to this review question are described in the review protocol in appendix A and for a full description of the methods see supplementary material C.
Declarations of interest were recorded according to NICE’s 2014 conflicts of interest policy until 31 March 2018. From 1 April 2018, declarations of interest were recorded according to NICE’s 2018 conflicts of interest policy. Those interests declared until April 2018 were reclassified according to NICE’s 2018 conflicts of interest policy (see Register of Interests).
Clinical evidence
Included studies
A systematic review of the clinical literature was conducted but no studies were identified which were applicable to this review question.
See the literature search strategy in appendix B and the study selection flow chart in appendix C.
Excluded studies
Studies not included in this review with reasons for their exclusions are provided in appendix K.
Summary of clinical studies included in the evidence review
No studies were identified which were applicable to this review question.
Quality assessment of clinical studies included in the evidence review
No studies were identified which were applicable to this review question.
Economic evidence
Included studies
A systematic review of the economic literature was conducted but no studies were identified which were applicable to this review question. See supplementary material D for further information.
Excluded studies
No studies were identified which were applicable to this review question.
Summary of studies included in the economic evidence review
No economic evaluations were identified which were applicable to this review question.
Economic model
This question was not prioritised for economic modelling because the evidence to base this on was anticipated to be limited.
Clinical evidence statements
No studies were identified which were applicable to this review question.
Economic evidence statements
No studies were identified which were applicable to this review question.
The committee’s discussion of the evidence
Interpreting the evidence
The outcomes that matter most
The committee considered the following three outcomes to be critical because they have the greatest impact on a woman’s quality of life and costs to the NHS: skin breakdown, ulcers, other procedures offered (i.e. surgery)/women moving to an alternative treatment option and incontinence specific health-related quality of life (e.g. ICIQ, BFLUTS, I-QOL, SUIQQ, UISS, SEAPI-QMM, ISI, KHQ and E-PAQ). The incidence of infection was an important outcome because urinary tract and skin infections are associated with significant morbidity. Patient satisfaction was an important outcome because these interventions affect daily life. No data for either the critical or important outcomes were identified.
The quality of the evidence
No clinical evidence on alternative treatment option review strategies for women who are using absorbent containment products was identified.
Benefits and harms
The committee was aware that no clinical evidence was available. The committee developed recommendations as part of this evidence review based on their clinical expertise and experience and by consensus. No recommendations had been made in the previous guidelines on how reviews for women who are using absorbent containment products should be undertaken, and how often or by whom.
The committee was aware of the need to review women who are using absorbent containment products to identify whether their condition had changed within the last 12 months and assess whether these women were suitable for alternative treatment options to reduce the need for long-term management with absorbent containment products. The committee agreed that reassessment at least once a year was necessary since some women currently may never have a review of their care once they had been given absorbent containment products. The committee discussed the important factors that need to be considered during this assessment. They were aware that there are many patient, lifestyle, social and environmental factors which may affect urinary incontinence and of the woman’s need for absorbent containment products should also be reviewed regularly. Women using absorbent containment products are prone to skin breakdown especially if there is prolonged contact with urine, and the committee recommended that this should be regularly assessed.
In particular the committee agreed that the review should include an examination to confirm skin integrity because containment products may result in vulval skin breakdown which can cause discomfort and distress.
Reviewing the impact of co-morbidities and their treatments may mean that alternatives to containment products can be offered. The committee agreed that a review should include assessments of:
- whether the product is needed at all
- whether it is effective (by assessing continence and the efficacy and quantities used)
- whether the product adversely affects the skin because of the residual moisture
- whether alternative short or long-term options should to be explored to see if another treatment may be suitable or preferable
- whether the use of the product impacts on other aspects of life (for example on lifestyle and comorbidities).
The committee agreed that the provision of routine review of the use of absorbent containment products will lead to:
- more reviews being undertaken
- provide access to opportunities for further care and support by trained professionals,
- prevent women remaining on long-term use of absorbent containment products when alternatives may be better options, thereby improving quality of life.
The committee acknowledged that there is variation in practice as to who actually carries out reviews of women who are using absorbent containment products, and variation in service provision. Reviews may be undertaken by a healthcare professional (for example, nurses, physiotherapists, or an assistant practitioner who works within a nursing service) or may be delegated to non-healthcare professionals. The committee was concerned that reviews may be being delegated to non-healthcare professionals without supervision by healthcare professionals trained in continence assessment, and noticed the need for recommendations on appropriate delegation. The committee decided that it was important to provide a recommendation to standardise practice to ensure that reviews are undertaken or supervised by healthcare professionals trained in continence assessment.
Due to the lack of evidence the committee also discussed whether a research recommendation was needed. However, they decided that it would be difficult to create a study where women would be given different approaches to reviews of absorbent containment products (how often and by whom) since this would vary widely and would need to be tailored to each individual woman’s preferences and circumstances. This was considered a low priority area for research.
Cost effectiveness and resource use
No economic evidence on alternative treatment option review strategies for women who are using absorbent containment products was available.
The committee expressed the view that many women are using absorbent containment products and it is a high-cost area for the NHS. Moreover, both women with SUI and a general UI population were being considered. As a result, small changes to the treatment review strategies are likely to have significant cost implications to the NHS. For example, every woman will need to be reviewed by someone with a certain skill and expertise every six months to a year. Therefore, only small differences in staff pay rates or merely changing the frequency from once to twice a year etc., would potentially have a large cost impact on the NHS. The committee discussed the potential cost implications associated with ensuring that services are adequately resourced to undertake routine reviews.
The committee explained that even though a more frequent review would be more costly in terms of staff costs it might identify the need for appropriate treatment sooner. Timely, appropriate and effective treatment could save substantial sums of money to the NHS. In most cases the trade-off is between the prolonged use of absorbent containment products, occasionally for up to 20 years, and the effective appropriate conservative or surgical treatment that may have high initial costs, but potentially prevent the long-term, inefficient use of pads. There is enormous waste associated with inappropriate use of conservative treatment options, mainly pads, and that this results in substantial costs to the NHS.
The committee noted that any additional treatment costs associated with undertaking any review strategy that leads to the timely identification, and appropriate treatment, of urinary incontinence would likely be outweighed by both the longer-term improvements in health outcomes and the potential future cost savings to the healthcare system. The committee agreed that delays in appropriate treatment exacerbate symptoms and worsen the condition (by not treating it effectively), leading to enormous waste in absorbent products (that is, pads and other associated consumables). Furthermore, providing appropriate treatment (conservative or surgical) may lead to substantial cost savings to the NHS through the reduction of prolonged and inefficient use of absorbent products. The costs of which, over time, add up to substantial sums to the NHS.
Other factors the committee took into account
The committee agreed that these recommendations should consider older women and those with cognitive and physical impairments who may particularly benefit from the recommendations.
References
No studies were identified which were applicable to this review question
Appendices
Appendix A. Review protocols
Review protocol for review question: How often, by whom and how should alternative treatment options be reviewed for women who are using absorbent containment products?
Appendix B. Literature search strategies
Literature search strategies for review question: How often, by whom and how should alternative treatment options be reviewed for women who are using absorbent containment products?
Database: Medline & Embase (Multifile)
Last searched on Embase Classic+Embase 1947 to 2017 April 27, Ovid MEDLINE(R) Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R) 1946 to Present
Date of last search: 28th April 2017
Database: Cochrane Library via Wiley Online
Database: Cinahl Plus
Appendix C. Clinical evidence study selection
Clinical evidence study selection for review question: How often, by whom and how should alternative treatment options be reviewed for women who are using absorbent containment products?
Appendix D. Clinical evidence tables
Clinical evidence tables for review question: How often, by whom and how should alternative treatment options be reviewed for women who are using absorbent containment products?
No studies were identified which were applicable to this review question.
Appendix E. Forest plots
Forest plots for review question: How often, by whom and how should alternative treatment options be reviewed for women who are using absorbent containment products?
No studies were identified which were applicable to this review question.
Appendix F. GRADE tables
GRADE tables for review question: How often, by whom and how should alternative treatment options be reviewed for women who are using absorbent containment products?
No studies were identified which were applicable to this review question.
Appendix G. Economic evidence study selection
Economic evidence study selection for review question: How often, by whom and how should alternative treatment options be reviewed for women who are using absorbent containment products?
One global search was conducted for this review question. See supplementary material D for further information.
Appendix H. Economic evidence tables
Economic evidence tables for review question: How often, by whom and how should alternative treatment options be reviewed for women who are using absorbent containment products?
No economic studies were identified which were applicable to this review question.
Appendix I. Economic evidence profiles
Economic evidence profiles for review question: How often, by whom and how should alternative treatment options be reviewed for women who are using absorbent containment products?
No economic studies were identified which were applicable to this review question.
Appendix J. Economic analysis
Economic evidence analysis for review question: How often, by whom and how should alternative treatment options be reviewed for women who are using absorbent containment products?
No economic analysis was conducted for this review question.
Appendix K. Excluded studies
Excluded studies for review question: How often, by whom and how should alternative treatment options be reviewed for women who are using absorbent containment products?
Clinical studies
Economic studies
No economic evidence was identified for this review question. See supplementary document D for further information.
Appendix L. Research recommendations
Research recommendations for review question: How often, by whom and how should alternative treatment options be reviewed for women who are using absorbent containment products?
No research recommendation was made for this review question.
Final
Evidence reviews
These evidence reviews were developed by the National Guideline Alliance hosted by the Royal College of Obstetricians and Gynaecologists
Disclaimer: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.
NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive. All NICE guidance is subject to regular review and may be updated or withdrawn.
- Evidence review for treatment options for women using absorbent containment prod...Evidence review for treatment options for women using absorbent containment products
Your browsing activity is empty.
Activity recording is turned off.
See more...