COMPARING THE EFFECTIVENESS OF CONTINENCE SERVICES - A FEASIBILITY STUDY

This paper describes one aspect of a study which examined the feasibil ity of conducting comparative studies of costs, quality and effectiven ess of continence services, in areas with different models of service delivery. Three different areas of the country where management and de livery of services represented, as nearly as possible, a description o f contrasting models of provision as outlined by the Department of Hea lth, were identified for the study. The focus of the study was women w ho had recently sought formal help with urinary incontinence and were likely to receive treatment or management in the community and a subgr oup of physically disabled women included to compare cost profiles for different client groups. The feasibility of recruiting matched sample s from these three sites in order to facilitate comparisons was explor ed. It was also necessary to identify appropriate timescales for the m easurement of patient outcomes related to continence service inputs an d to determine the availability of cost data for services provided at an individual patient level The study concluded that comparative studi es of the costs, quality and effectiveness of different service models are not feasible, given the current rate of change in service structu res and the fact that continence services are made up of many disparat e elements which may not be related in the coherent way that the phras e 'models of service' suggests. It may well, however, be more useful t o evaluate service provision in any one area by comparisons of change over time. It is also recommended that effort could be more usefully d evoted to a systematic study of the cost effectiveness of particular i nterventions, or specific service innovations for urinary incontinence . The other part of the study which is described in detail elsewhere i nvolved the piloting of instruments to collect patients' views and per ceptions of services in relation to costs, quality and effectiveness. The aim was to develop questions which patients could understand and a nswer easily rather than to collect responses for analysis and interpr etation.