Does the GP treat elderly people differently than is advised in the NHG Standard for Incontinence? If so, why? [Handelt de huisarts bij ouderen anders dan de NHG-Standaard Incontinence voor urine adviseert? En zo ja, waarom?]

Aim: To discover when and why GPs deal with patients differently than is advised in the NHG Standard for Urine Incontinence. Method: The investigation is part of a larger study of urine incontinence (UI) in the elderly. We invited elderly people with uncomplicated UI, who had not previously received treatment for the condition but did wish to be treated, to go to their GP. After each consultation the GP filled in a self-registration form recording the extent to which he had followed the guidelines contained in the NHG Standard for Urine Incontinence. The researcher later discussed with the GPs why they had deviated from the Standard. Results: A total of 19 men and 71 women visited their GP. During the anamnesis, the physical examination and the urine check the GPs kept to the Standard on all points. However the GPs did sometimes deviate from the Standard in the treatment phase. One sixth of the men and women decided not to undergo treatment because they regarded the UI not sufficiently severe to merit the effort they would be required to make in the exercise therapy. When it was possible to identify comorbidity, both the GP and the patient regarded the UI as more complex, also because they had to choose which medical problem was to be preferentially treated. The GPs found mixed incontinence in particular as too complex and time-consuming to treat themselves. Conclusion: The NHG Standard for Urine Incontinence applies well to elderly patient where anamnesis, physical examination and the urine check are concerned, but applies to a lesser extent in the treatment. The three main reasons for this are: the patient finds the treatment not worth the effort; because of comorbidity patient and doctor must choose which condition is given preferential treatment; and the GP finds the treatment of UI in the elderly complex and time-consuming