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Gage H, Williams P, Avery M, Murphy C, Fader M. Long-term catheter management in the community: a population-based analysis of user characteristics, service utilisation and costs in England. Prim Health Care Res Dev 2024; 25:e13. [PMID: 38450589 PMCID: PMC10940055 DOI: 10.1017/s1463423624000021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 12/28/2023] [Accepted: 12/30/2023] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Long-term urinary catheters are problematic and burdensome for patients, carers and health services. Nursing practice to improve the management of long-term urinary catheters has been held back by a lack of evidence to support policy and practice. Little is known about who uses a catheter long term and the resources and costs needed for their management. Understanding these costs will help to target innovations to improve care. There have been no substantial innovations to urinary catheters or their management recently and no publications to characterise users and costs. AIM To describe long-term catheter users and explore catheter-related service use and costs in England. METHODS Descriptive information on the characteristics of catheter users and their use of services was obtained from: General Practice records (n = 607), district nursing records (n = 303), questionnaires to patients (n = 333) and triangulated, 2009-2012. Annual service costs (British pounds 2011) were computed. FINDINGS Most catheter users (59.6%) were men, nearly three-quarters (71.2%) were over 70 years and 60.8% used a urethral catheter. Women tended to be younger than men and more likely to use a suprapubic catheter. The services used most frequently over 12 months were general practitioner (by 63.1%) and out of hours services (43.0%); 15.5% accessed Accident and Emergency services for urgent catheter-related care. Hospital use accounted for nearly half (48.9%) of total health service costs (mainly due to inpatient stays by 13.6% of participants); catheter supplies/medications were next most costly (25.7%). Half of all costs were accounted for by 14.2% of users. The median annual cost of services used was £6.38, IQR: £344-£1324; district nursing services added approximately a further £200 per annum. CONCLUSIONS Finding better ways to reduce catheter problems (e.g. blockage, infection) that cause unplanned visits, urgent or hospital care should be a priority to improve quality of life for long-term catheter users and reduce health service expenditure.
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Affiliation(s)
- Heather Gage
- Surrey Health Economics Centre, Department of Clinical and Experimental Medicine, School of Economics, University of Surrey, Guildford, England
| | - Peter Williams
- Department of Mathematics and Physicas, University of Surrey, Guildford, England
| | - Miriam Avery
- Continence Technology and Skin Health Group, School of Health Sciences, University of Southampton, Southampton, England
| | - Catherine Murphy
- Bladder and Bowel Management Research Group, School of Health Sciences, University of Southampton, Southampton, England
| | - Mandy Fader
- Bladder and Bowel Management Research Group, School of Health Sciences, University of Southampton, Southampton, England
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Youssef N, Shepherd A, Best C, Hagen S, Mackay W, Waddell D, El Sebaee H. The Quality of Life of Patients Living with a Urinary Catheter and Its Associated Factors: A Cross-Sectional Study in Egypt. Healthcare (Basel) 2023; 11:2266. [PMID: 37628463 PMCID: PMC10454127 DOI: 10.3390/healthcare11162266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/31/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND In Arabic countries, no research has focused on the experience of patients with indwelling urinary catheters. This cross-sectional study is the first to evaluate the catheter-specific quality of life (QoL) of patients living with a urinary catheter in Egypt. METHODS This study was conducted from April to September 2017, using a convenience sample of patients from a University Hospital. Data were collected using the International Consultation on Incontinence Questionnaire-Long-Term Catheter QoL (ICIQ-LTCQoL) instrument, along with a demographic datasheet. RESULTS 141 were enrolled, with 47.5% inpatients, 52.5% outpatients. A total of 70.9% reported problems with catheter function, and 92.2% reported that the catheter affected their daily lives. Place (inpatient or outpatient) was significantly associated with the total score of the ICIQ-LTCQoL (mean difference (MD) 6.34 (95% CI: 3.0 to 9.73)) and both subscales (catheter function subscale: MD = 4.92 (95% CI: 2.12 to 7.73) and lifestyle impact subscale: MD = 1.44 (95% CI: 0.3 to 2.63)), suggesting that outpatients have poorer QoL than inpatients. Moreover, catheter material was significantly related to the catheter function domain with Silicone Foley Catheter (100% Silicon) users experiencing poorer QoL related to catheter function than those with Latex Foley Catheter (Silicon-coated) (MD 4.43 (95% CI: 0.62 to 8.24). Workers/employees were found to have poorer QoL than those who were retired (MD = 4.94 (95% CI: 0.3 to 9.63)). CONCLUSION The results highlight the necessity of assessing function and concern regarding urinary catheter use and its impact on QoL, as well as its determinants. Evidence-based educational programs should be designed to enhance patients' self-care abilities to relieve their sense of distress and enhance their confidence in caring for their catheters.
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Affiliation(s)
- Naglaa Youssef
- Department of Medical-Surgical Nursing, College of Nursing, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Ashley Shepherd
- Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK
| | - Catherine Best
- Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK
| | - Suzanne Hagen
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - William Mackay
- School of Health and Life Sciences, University of the West of Scotland, Paisley PA1 2BE, UK
| | - Debbie Waddell
- Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK
| | - Hanan El Sebaee
- Medical-Surgical Nursing Department, Faculty of Nursing, Cairo University, Cairo 11562, Egypt
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Abdel-fattah M, Johnson D, Constable L, Thomas R, Cotton S, Tripathee S, Cooper D, Boran S, Dimitropoulos K, Evans S, Granitsiotis P, Hashim H, Kilonzo M, Larcombe J, Little P, MacLennan S, Murchie P, Myint PK, N’Dow J, Norrie J, Omar MI, Paterson C, Scotland G, Thiruchelvam N, MacLennan G. Randomised controlled trial comparing the clinical and cost-effectiveness of various washout policies versus no washout policy in preventing catheter associated complications in adults living with long-term catheters: study protocol for the CATHETER II study. Trials 2022; 23:630. [PMID: 35927733 PMCID: PMC9351274 DOI: 10.1186/s13063-022-06577-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Various washout policies are widely used in adults living with long-term catheters (LTC). There is currently insufficient evidence on the benefits and potential harms of prophylactic LTC washout policies in the prevention of blockages and other LTC-related adverse events, such as urinary tract infections. CATHETER II tests the hypothesis that weekly prophylactic LTC washouts (normal saline or citric acid) in addition to standard LTC care reduce the incidence of catheter blockage requiring intervention compared to standard LTC care only in adults living with LTC. METHODS CATHETER II is a pragmatic three-arm open multi-centre superiority randomised controlled trial with an internal pilot, economic analysis, and embedded qualitative study. Eligible participants are adults aged ≥ 18 years, who have had a LTC in use for ≥ 28 days, have no plans to discontinue the use of the catheter, are able to undertake the catheter washouts, and complete trial documentation or have a carer able to help them. Participants are identified from general practitioner practices, secondary/tertiary care, community healthcare, care homes, and via public advertising strategies. Participants are randomised 1:1:1 to receive a weekly saline (0.9%) washout in addition to standard LTC care, a weekly citric acid (3.23%) washout in addition to standard LTC care or standard LTC care only. Participants and/or carers will receive training to administer the washouts. Patient-reported outcomes are collected at baseline and for 24 months post-randomisation. The primary clinical outcome is catheter blockage requiring intervention up to 24 months post-randomisation expressed per 1000 catheter days. Secondary outcomes include symptomatic catheter-associated urinary tract infection requiring antibiotics, catheter change, adverse events, NHS/ healthcare use, and impact on quality of life. DISCUSSION This study will guide treatment decision-making and clinical practice guidelines regarding the effectiveness of various prophylactic catheter washout policies in men and women living with LTC. This research has received ethical approval from Wales Research Ethics Committee 6 (19/WA/0015). TRIAL REGISTRATION ISRCTN ISRCTN17116445 . Registered prospectively on 06 November 2019.
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Affiliation(s)
- Mohamed Abdel-fattah
- grid.7107.10000 0004 1936 7291Aberdeen Centre for Women’s Health Research, University of Aberdeen, Aberdeen, UK
| | - Diana Johnson
- grid.7107.10000 0004 1936 7291Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - Lynda Constable
- grid.7107.10000 0004 1936 7291Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - Ruth Thomas
- grid.7107.10000 0004 1936 7291Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - Seonaidh Cotton
- grid.7107.10000 0004 1936 7291Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - Sheela Tripathee
- grid.7107.10000 0004 1936 7291Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - David Cooper
- grid.7107.10000 0004 1936 7291Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Sue Boran
- The Queen’s Nursing Institute, London, UK
| | | | | | | | - Hashim Hashim
- grid.418484.50000 0004 0380 7221North Bristol NHS Trust, Bristol, UK
| | - Mary Kilonzo
- grid.7107.10000 0004 1936 7291Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Paul Little
- grid.5491.90000 0004 1936 9297Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Sara MacLennan
- grid.7107.10000 0004 1936 7291Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Peter Murchie
- grid.7107.10000 0004 1936 7291Academic Primary Care Research Group, University of Aberdeen, Aberdeen, UK
| | - Phyo Kyaw Myint
- grid.7107.10000 0004 1936 7291Ageing Clinical & Experimental Research Team, University of Aberdeen, Aberdeen, UK
| | - James N’Dow
- grid.7107.10000 0004 1936 7291Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - John Norrie
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Muhammad Imran Omar
- grid.7107.10000 0004 1936 7291Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Catherine Paterson
- grid.1039.b0000 0004 0385 7472School of Nursing, Midwifery and Public Health, University of Canberra, Canberra, Australia
| | - Graham Scotland
- grid.7107.10000 0004 1936 7291Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Nikesh Thiruchelvam
- grid.24029.3d0000 0004 0383 8386Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Graeme MacLennan
- grid.7107.10000 0004 1936 7291Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
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Youssef N, Best C, Mackay WG, Hagen S, Shepherd A. Psychometric properties of the Arabic version of the International Consultation on Incontinence Questionnaire on Long-Term Catheter Quality of Life. Int J Nurs Pract 2019; 26:e12807. [PMID: 31854071 DOI: 10.1111/ijn.12807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 10/25/2019] [Accepted: 11/09/2019] [Indexed: 11/28/2022]
Abstract
AIM To translate the International Consultation on Incontinence Questionnaire (ICIQ) Long-Term Catheter Quality of Life (LTCqol) questionnaire (ICIQ-LTCqol) from English to Arabic and evaluate its psychometric properties. BACKGROUND Currently, no tool for Arabic-speaking patients is available to measure the quality of life in patients using long-term urinary catheters. DESIGN Translation and psychometric assessment of questionnaire. METHODS The internal consistency and construct validity of the translated Arabic version of the ICIQ-LTCqol were evaluated in a convenience sample of 141 participants recruited from a hospital in Egypt from April to September 2017. Test-retest reliability was assessed for a sample of 15 participants who completed this version at two time points. Construct validity was assessed by factor analysis. RESULTS The translated Arabic version of the ICIQ-LTCqol showed satisfactory test-retest reliability and internal consistency, with the Cronbach α = .75. Confirmatory factor analysis confirmed the same two factors ("catheter function" and "lifestyle") structure as found in the English version of the tool supporting the construct validity of the translated questionnaire. CONCLUSION This original and significant study allows, for the first time, researchers and clinicians working with Arabic-speaking patients, the opportunity to evaluate the quality of life in long-term urinary catheter users.
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Affiliation(s)
- Naglaa Youssef
- College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.,Faculty of Nursing, Cairo University, Giza, Egypt
| | - Catherine Best
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - William Gordon Mackay
- Institute of Healthcare Policy and Practice, School of Health and Life Sciences, University of the West of Scotland, Paisley, UK
| | - Suzanne Hagen
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Ashley Shepherd
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
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