Trends in Urodynamic Procedures, Surgical Procedures, and Overall Health Resource Utilization in the Adult Taiwanese Population With Urinary Incontinence: A Secondary Data Analysis

10.1097/jnr.0000000000000254

Lan-Fang HSU；Ling-Yin CHANG；Yuan-Mei LIAO；Shauh-Der YEH；Pei-Shan TSAI

urinary incontinence ； urodynamic procedures ； surgical procedures ； healthcare utilization ； National Health Insurance Research Database

The Journal of Nursing Research

26卷6期（2018 / 12 / 01）

438 - 445

英文

Background: The prevalence and incidence of the main risk factors for urinary incontinence (UI) have both increased over time. In addition, official statistics indicate that Taiwan is on course to evolve from an aging society into an aged society within the next decade. However, most of the studies in the literature that address the natural history of UI target Western and other non-Asian populations. Taiwan lacks knowledge of the natural history of UI. Purpose: The aims of this research were to study the trends in the use of urodynamic and surgical procedures for various subtypes of UI and to investigate the relationship between UI and healthcare resource utilization. Methods: The data on 1 million, randomly selected people who were enrolled in the Taiwan National Health Insurance program between 2000 and 2008 were extracted from the Longitudinal Health Insurance Database. The population and all procedures were identified based on the International Classification of Disease, Ninth Revision, Clinical Modification codes. Annual incidence of UI was calculated on an annual basis, and trend analysis was performed using logistic regression models. The association between UI and healthcare utilization was examined using generalized linear models in a gamma distribution with a log link function. Results: Overall, the trend in the annual incidence for all types of UI increased significantly (p ＜ .01). Significantly increasing trends in the use of urodynamic procedures over time were observed for mixed and other types of UI (p ＜ .01). In addition, a significantly increasing trend was observed in the annual rates of surgical procedures that were received by patients with urge or stress UI (p ＜ .05). Patients with UI showed significantly higher healthcare resource utilization, including number of ambulatory visits, number of hospitalizations, average ambulatory care expenditures, and average days of hospitalization, than those without UI. However, limited information is available on the conservative treatment of UI in the database. Conclusions: UI symptoms may lead to increased healthcare resource utilization in patients with UI.

1. Abrams, P.(Ed.),Cardozo, L.(Ed.),Khoury, S.(Ed.),Wein, A.(Ed.)(2013).Incontinence.Paris, France:European Association of Urology.
2. Abrams, P.,Cardozo, L.,Fall, M.,Griffiths, D.,Rosier, P.,Ulmsten, U.,Standardisation Sub-committee of the International Continence Society(2002).The standardisation of terminology of lower urinary tract function: Report from the Standardisation Subcommittee of the International Continence Society.Neurourology Urodynamics,21(2),167-178.
3. Albers-Heitner, P.,Berghmans, B.,Nieman, F.,Lagro-Janssen, T.,Winkens, R.(2008).Adherence to professional guidelines for patients with urinary incontinence by general practitioners: A cross-sectional study.Journal of Evaluation in Clinical Practice,14(5),807-811.
4. Arne,M.,Lundin, F.,Boman, G.,Janson, C.,Janson, S.,Emtner, M.(2011).Factors associated with good self-rated health and quality of life in subjects with self-reported COPD.International Journal of COPD,6,511-519.
5. Barber, J.,Thompson, S.(2004).Multiple regression of cost data: Use of generalised linear models.Journal of Health Services Research & Policy,9(4),197-204.
6. Bartoli, S.,Aguzzi, G.,Tarricone, R.(2010).Impact on quality of life of urinary incontinence and overactive bladder: A systematic literature review.Urology,75(3),491-500.
7. Bettez, M.,Tu, L. M.,Carlson, K.,Corcos, J.,Gajewski, J.,Jolivet, M.,Bailly, G.(2012).2012 Update: Guidelines for adult urinary incontinence collaborative consensus document for the Canadian Urological Association.Canadian Urological Association Journal,6(5),354-363.
8. Boltz, M.,Capezuti, E.,Fulmer, T.,Zwicker, D.(2011).Evidence-based geriatric nursing protocols for best practice.New York, NY:Springer.
9. Burkhard, F. C.,Lucas, M. G.,Berghmans, L. C.,Bosch, J. L. H. R.,Cruz, F.,Lemack, G. E.,Tubaro, A.(2016).EAU guidelines on urinary incontinence in adults.Arnhem, The Netherlands:European Association of Urology.
10. Chamberlain, A. M.,Manemann, S. M.,Dunlay, S. M.,Spertus, J. A.,Moser, D. K.,Berardi, C.,Roger, V. L.(2014).Self-rated health predicts healthcare utilization in heart failure.Journal of the American Heart Association,3(3),e000931.
11. Coyne, K. S.,Sexton, C. C.,Irwin, D. E.,Kopp, Z. S.,Kelleher, C. J.,Milsom, I.(2008).The impact of overactive bladder, incontinence and other lower urinary tract symptoms on quality of life, work productivity, sexuality and emotional well-being in men and women: Results from the EPIC study.BJU International,101(11),1388-1395.
12. Coyne, K. S.,Zhou, Z.,Thompson, C.,Versi, E.(2003).The impact on health-related quality of life of stress, urge and mixed urinary incontinence.BJU International,92(7),731-735.
13. da Silva, V. A.,D'Elboux, M. J.(2012).Nurses' interventions in the management of urinary incontinence in the elderly: An integrative review.The University of São Paulo Nursing School Journal,46(5),1221-1226.
14. Department of Statistics, Ministry of the Interior, Taiwan, ROC. (2016). Interior national indicators. Retrieved from http://www.moi.gov.tw/stat/english/interior.asp
15. Dingwall, L.(2008).Promoting effective continence care for older people: A literature review.BJN: British Journal of Nursing,17(3),166-172.
16. Dumoulin, C.,Hay-Smith, J.(2008).Pelvic floor muscle training versus no treatment for urinary incontinence in women. A Cochrane systematic review.European Journal of Physical Rehabilitation Medicine,44(1),47-63.
17. Fu, S.,Huang, N.,Chou, Y. J.(2014).Trends in the prevalence of multiple chronic conditions in Taiwan from 2000 to 2010: A population-based study.Preventing Chronic Disease,11,E187.
18. Fu, T. S.,Lee, C. S.,Gunnell, D.,Lee, W. C.,Cheng, A. T.(2013).Changing trends in the prevalence of common mental disorders in Taiwan: A 20-year repeated cross-sectional survey.The Lancet,381(9862),235-241.
19. Giersson, G.,Fall, M.,Lindström, S.(1993).Cystometric subtypes of bladder overactivity: A retrospective analysis of 501 patients.International Urogynecology Journal,4(4),186-193.
20. Harris, S. S.,Link, C. L.,Tennstedt, S. L.,Kusek, J. W.,McKinlay, J. B.(2007).Care seeking and treatment for urinary incontinence in a diverse population.The Journal of Urology,177(2),680-684.
21. John, G.,Gerstel, E.,Jung, M.,Dällenbach, P.,Faltin, D.,Petoud, V.,Rutschmann, O. T.(2014).Urinary incontinence as a marker of higher mortality in patients receiving homecare services.BJU International,113(1),113-119.
22. Keleher, H.,Parker, R.,Abdulwadud, O.,Francis, K.(2009).Systematic review of the effectiveness of primary care nursing.International Journal of Nursing Practice,15(1),16-24.
23. Labrie, J.,Berghmans, B. L.,Fischer, K.,Milani, A. L.,van der Wijk, I.,Smalbraak, D. J.,van der Vaart, C. H.(2013).Surgery versus physiotherapy for stress urinary incontinence.The New England Journal of Medicine,369(12),1124-1133.
24. Lee, J. P.,Chen, C. H.,Wu, Y. T.,Hung, H. C.,Tsauo, J. Y.(2006).Medical utilization and cost of outpatient visits in women with stress urinary.Formosan Journal of Physical Therapy,31(2),112-117.
25. Lucas, M. G.,Bedretdinova, D.,Berghmans, L. C.,Bosch, J. L. H. R.,Burkhard, F. C.,Cruz, F.,Pickard, R. S.(2015).Guidelines on urinary incontinence.Arnhem, The Netherlands:European Association of Urology.
26. Martin-Misener, R.,Harbman, P.,Donald, F.,Reid, K.,Kilpatrick, K.,Carter, N.,I DiCenso, A.(2015).Cost-effectiveness of nurse practitioners in primary and specialised ambulatory care: Systematic review.BMJ Open,5(6),e007167.
27. Minassian, V. A.,Yan, X.,Lichtenfeld, M. J.,Sun, H.,Stewart, W. F.(2012).The iceberg of health care utilization in women with urinary incontinence.International Urogynecology Journal,23(8),1087-1093.
28. Penning-van Beest, F. J.,Sturkenboom, M. C.,Bemelmans, B. L.,Herings, R. M.(2005).Undertreatment of urinary incontinence in general practice.Annals of Pharmacotherapy,39(1),17-21.
29. Rosier, P. F.(2013).The evidence for urodynamic investigation of patients with symptoms of urinary incontinence.F1000Prime Reports,5,8.
30. Shaw, C.(2001).A review of the psychosocial predictors of help-seeking behaviour and impact on quality of life in people with urinary incontinence.Journal of Clinical Nursing,10(1),15-24.
31. U.S. Department of Health & Human Services (Ed.)(2012).Comparative effectiveness review summary guides for clinicians.Rockville, MD:Agency for Healthcare Research and Quality.
32. Van Gerwen, M. A.,Schellevis, F. G.,Lagro-Janssen, A. L.(2009).Management of urinary incontinence in general practice: Data from the Second Dutch National Survey.Journal of Evaluation in Clinical Practice,15(2),341-345.
33. Wells, M.(2000).The role of the nurse in urinary incontinence. Bailliere's Best Practice & Research.Clinical Obstetrics & Gynaecology,14(2),335-354.
34. World Health Organization. (2017). The top 10 causes of death. Retrieved from http://www.who.int/mediacentre/factsheets/fs310/en/
35. Wu, M. P.,Hsu, Y. W.,Weng, S. F.,Ho, C. H.,Wang, J. J.,Tong, Y. C.(2013).Healthcare-seeking prevalence of lower urinary tract symptoms among national health insurance enrollees in Taiwan, 2000-2009.Urology,81(1),61-65.