A survey of 65 community continence services in England has revealed the benefits and drawbacks of phone assessments, published in BMC Health Services Research.
Like many NHS services, community continence services had to adapt to the COVID-19 pandemic. This meant doing more assessments remotely, usually over the phone but also by video call. Some continence services stopped completely.
The research team included members from the Universities of Bristol and the West of England, Bladder and Bowel UK, ERIC – The Children’s Bowel and Bladder Charity and the Bristol Urological Institute. They wanted to hear from community continence professionals about the changes to how services are delivered and the impact these changes had on how patients were? cared for. The study was supported by the National Institute for Health and Care Research Applied Collaboration West (NIHR ARC West) and the Elizabeth Blackwell Institute at the University of Bristol.
The results show that experiences of remote incontinence assessments during the pandemic were mixed. They were more convenient for many patients and the professionals delivering them and could lessen feelings of embarrassment when reporting problems. However, problems such as skin damage associated with incontinence could be more easily missed and some patients with continence problems, such as children and older people, have more limited access to technology.
The benefits of remote assessments included continuity of the service during pandemic, convenience and accessibility for some patient groups, and more efficient use of time for professionals.
However, physical examinations and routine tests could not be done during a remote appointment. This meant continence professionals had to decide which patients needed to be seen at a later in-person appointment.
Continence professionals’ concerns about remote assessments included missing problems and diagnoses, giving the wrong care, difficulty spotting safety concerns and challenges building the patient / professional relationship.
A third of services reported that staff had been redeployed or had patients added to their caseload that would normally have been looked after by another team.
Staff redeployment had resulted in long waiting times for many people living with continence problems, and some being left without care. Continence professionals perceived that continence care was undervalued. They called for greater recognition of its preventative role and potential to improve quality of life.
Dr Cecily Palmer, Senior Research Associate at NIHR ARC West and lead author of the study, said:
“Our study identifies benefits and disadvantages to doing assessments by phone/video. Although a necessary safety response to the challenge of COVID-19; our findings show that remote assessments work well in some ways and for some patients but may affect the quality of the care given, and disadvantage some patient groups.”
A range of appointment options should be offered, and involve consideration of patients’ circumstances and needs.
Nikki Cotterill, Professor of Continence Care at the University of the West of England, BABCON HIT Director and principal investigator on the study, said:
“Continence services play a vital role in prevention and treatment of bladder and bowel leakage. Strong evidence exists for the physical and mental health impact, and decreased quality of life for men, women and children experiencing these difficulties. Continence services must be prioritised, accessibility promoted, and staffed to provide high quality continence care.”