Penny Peel’s research while affiliated with Royal College of Physicians and other places

systematic collection of clinical outcome data remains the most difficult task in the measurement of clinical effectiveness. However, the examination of the relationship between organisational and clinical process of care may provide a surrogate measure of quality in care. data from the 2006 National Audit of Continence Care for Older People were used to examine whether there was an association between organisational structure and standard of continence care for older people. 'Quality' scores were produced and the relationship between scores was examined. there were statistically significant correlations between organisational and process scores for continence care. Primary care scored higher than hospitals or care homes in regard to service organisation [median (IQR): 57 (45-68) vs 48 (36-65) vs 50 (38-55), P = 0.001]. Differences were less with clinical process scores for urinary incontinence (UI) [median (IQR): 42 (32-52) vs 40 (29-49) vs 43 (34-52), P = 0.06] and for faecal incontinence (FI) [median: 42 (34-53) vs 45 (36-55) vs 47 (41-53), P = 0.12]. those with an integrated service provide higher quality care to older people. The provision of high-quality care for continence appears to be dependent upon well-organised services with personnel who have the appropriate training and skills to deliver the care.

INTRODUCTION: A number of policy documents have identified deficiencies in continence services in England and Wales, and have called for the development of integrated services. A national audit was conducted to assess the quality of continence care for older people and whether these requirements have been met. METHODS: The audit studied incontinent individuals aged 65 years and older. Each site returned data on organizational structure and the process of 20 patient's care. Data were submitted via the Internet, all were anonymous. RESULTS: The national audit was conducted across England, Wales, and Northern Ireland. Data on the care of patients/residents with bladder problems were returned by 141 of 326 (43%) Primary Care Trusts, 159 of 196 (81 %) secondary/acute care trusts (198 hospitals), and 29 of 309 (9%) invited care homes. Fifty-eight percent of Primary Care Trusts, 48% of hospitals, and 74% of care homes reported that integrated continence services existed in their area. While basic provision of care appeared to be in place, the audit identified deficiencies in the organization of services and in the assessment and management of urinary incontinence in the elderly. CONCLUSION: The requirement for integrated continence services has not yet been met. Assessment and care by professionals directly looking after the older person were often lacking. There is an urgent need to reestablish the fundamentals of continence care into the practice of medical and nursing staff, and action needs to be taken with regard to the establishment of truly integrated quality services in this neglected area of practice.

the Department of Health report 'Good practice in continence services' highlights the need for proper assessment and management of urinary incontinence. The National Service Framework for Older People required service providers to establish integrated continence services by April 2004. A national audit was conducted to assess the quality of continence care for older people and whether these requirements have been met. the audit studied incontinent individuals of 65 years and over. Each site returned data on organisational structure and the process of 20 patients' care. Data were submitted via the internet, and all were anonymous. the national audit was conducted across England, Wales and Northern Ireland. Data on the care of patients/residents with bladder problems were returned by 141/326 (43%) of primary care trusts (PCT), by 159/196 (81%) of secondary care trusts (involving 198 hospitals) and by 29/309 (9%) of invited care homes. In all 58% of PCT, 48% of hospitals and 74% of care homes reported that integrated continence services existed in their area. Whilst basic provision of care appeared to be in place, the audit identified deficiencies in the organisation of services, and in the assessment and management of urinary incontinence in the elderly. the results of this audit indicate that the requirement for integrated continence services has not yet been met. Assessment and care by professionals directly looking after the older person were often lacking. There is an urgent need to re-establish the fundamentals of continence care into the practice of medical and nursing staff and action needs to be taken with regard to the establishment of truly integrated, quality services in this neglected area of practice.

A number of policy documents have identified deficiencies in continence services in England and Wales, and have called for the development of integrated services. A national audit was conducted to assess the quality of continence care for older people and whether these requirements have been met. The audit studied incontinent individuals aged 65 years and older. Each site returned data on organizational structure and the process of 20 patient's care. Data were submitted via the Internet, all were anonymous. The national audit was conducted across England, Wales, and Northern Ireland. Data on the care of patients/residents with bladder problems were returned by 141 of 326 (43%) Primary Care Trusts, 159 of 196 (81%) secondary/acute care trusts (198 hospitals), and 29 of 309 (9%) invited care homes. Fifty-eight percent of Primary Care Trusts, 48% of hospitals, and 74% of care homes reported that integrated continence services existed in their area. While basic provision of care appeared to be in place, the audit identified deficiencies in the organization of services and in the assessment and management of urinary incontinence in the elderly. The requirement for integrated continence services has not yet been met. Assessment and care by professionals directly looking after the older person were often lacking. There is an urgent need to reestablish the fundamentals of continence care into the practice of medical and nursing staff, and action needs to be taken with regard to the establishment of truly integrated quality services in this neglected area of practice.

Faecal incontinence in older people is associated with considerable morbidity but is amenable to successful management. Quality standards in this area were previously subject to a pilot audit in primary, secondary care and care homes to allow providers to compare the care delivered by their service to others and to monitor the development of integrated continence services as set out in the National Service Framework for Older People. This study reports the results of the national audit. Data were returned by 141 primary care sites, 159 secondary care trusts (involving 198 hospitals) and 29 care homes. Data on the care of 3,059 patients/residents with bowel problems were analysed. Fifty-eight per cent of Primary Care Trusts (PCTs), 48% of hospitals and 74% of care homes reported that integrated continence services existed in their areas. Whilst basic provision of care appeared to be in place, the audit identified deficiencies in the organisation of services and in the assessment and management of faecal incontinence. The results of this audit indicate that the requirement for integrated continence services contained within the National Service Framework for Older People has not yet been met. Basic assessment and care by the professionals directly looking after older persons is often lacking. There is an urgent need to re-establish the fundamentals of continence care into the daily practice of medical and nursing staff, and undoubtedly, action needs to be taken with regard to the establishment of truly integrated, quality services in this neglected area of practice.