Sponsible for urinary continence care and is

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sponsible for urinary continence care and is specially trained to carry out physical examinations, prescribe drugs and containment products, and refer patients to specialist care. Effectiveness estimates of care provided by the nurse Franken et al. BMC Family Practice (2018) 19:31 Page 2 of 11
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specialist in terms of improvement of the condition (mean 21%) and successfully treated (mean 31%) were based on a randomised controlled trial (RCT) by Subak et al. [ 18 ]. The international awareness study [ 19 ] provided input for the estimations regarding the improvement of case- detection, as this study indicated that the majority of in- continence patients go undetected [ 16 ]. Given the lack of evidence, no effects were assigned to improvements related to case coordination. Patient population As in the previous model, the patient population con- sists of community-dwelling elderly patients ( 65 years) with four or more chronic diseases. The definition of chronic disease was based on an existing list of the International Classification of Primary Care (the ICPC-2 codes of O Halloran [ 20 ] were recoded to ICPC-1 codes used by the Dutch database). The target population was estimated using data from two national databases (Statistics Netherlands and the National Institute for Health Services [NIVEL] Primary Care Database) in combination with incidence and prevalence data from the literature (Teunissen et al. [ 2 ] and Uijen et al. [ 21 ]). Full details are published in Holtzer-Goor et al. [ 16 ]. Table 1 shows the key characteristics of the patient population in the model. Decision analytical model The decision analytical model was developed to estimate the incremental cost-effectiveness of the implementation of the OCSS for urinary incontinence in The Netherlands [ 16 ]. The model captures the complete pathway of Dutch patients as identified by a series of interviews with health- care experts (3 GPs, 3 pelvic physiotherapists, 2 continence nurses, 3 gynaecologists, 2 surgeons, 2 urologists, a geriat- ric specialist, a gastroenterologist, and a pharmacists [ 16 ]). The pathway included a detection phase (detected and never detected) and a treatment phase (treatment for cure Table 1 Key characteristics of the patient population and overview of the settings of the current situation and the 2030 scenarios Parameter Current situation (2014) Scenario 1 (2030) Scenario 2 (2030) Scenario 3 (2030) Scenario 4 (2030) Number of community-dwelling elderly with 4 chronic diseases a 860,741 1,420,369 (3.18% annual increase e ) 1,420,369 1,420,369 1,420,369 Total number of urinary incontinence cases in population (prevalent/ incident) 215,185/ 55,087 355,092/ 90,904 355,092/90,904 355,092/90,904 355,092/90,904 % of the population annually admitted to a nursing home 4% f 4% 4% 4% 2.95% Number of patient-years ¥ 914,598 1,512,157 1,512,157 1,512,157 1,526,030 Formal home care (covered by insurance) (annual: 2% reduction of users, and 1% increase of # hours) (annual: 2% reduction of users, and 1% increase of # hours) (annual: 1% increase of # of hours) % users 47% b 47% 34.7% 34.7% 47% # hours per week 6.4 h g 6.4 h 7.4 h 7.4 h 7.4 h Reduction in home care in improved/ success cases 10%/ 25% of number of hours (=0.64/ 1.6 h) c 0.64/ 1.6 h 0.64/ 1.6 h 0.64/ 1.6 h 0.64/ 1.6 h Informal care (time of partner/ family/ friends)
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