Verpleegkunde Nummer 1 , pp. 7-14
mrt 2022, jaargang 37
Verpleegkunde Nr. 1 , pp. 7-14
mrt 2022, jr. 37
Onderzoeksartikel

Hoge nood? Onderzoek in een huisartsenpraktijk naar urine-incontinentie bij oudere, thuiswonende vrouwen

DOEL
Het in een huisartsenpraktijk nagaan van de prevalentie, soort, ernst en hinder van urine-incontinentie en de invloed daarvan op de kwaliteit van leven van oudere, thuiswonende vrouwen.

METHODE
Thuiswonende vrouwen vanaf 60 jaar die op 9 juni 2020 stonden ingeschreven bij een huisarts in Grave werden gevraagd om een vragenlijst in te vullen. De aanwezigheid, soort, ernst en hinder van de urine-incontinentie werden uitgevraagd met de Michigan Incontinence Symptom Index (M-ISI) en de kwaliteit van leven met de 12-Item Short Form Health Survey (SF-12). Beschrijvende en toetsende analyses werden uitgevoerd om de uitkomsten te beschrijven en om subgroepen op basis van de soort en ernst van de urine-incontinentie te vergelijken op hinder en kwaliteit van leven.

RESULTATEN
Van de 216 aangeschreven vrouwen retourneerden 125 vrouwen (gemiddelde leeftijd 74 jaar) een ingevulde vragenlijst(respons 58%). Bij 54 vrouwen (43%) was sprake van urine-incontinentie: bij 13 vrouwen (10%) stressincontinentie, 14 vrouwen (11%)urge-incontinentie en 27 vrouwen (22%) gemengde incontinentie. Vrijwel al deze vrouwen (83%) gebruikten daarom opvangmateriaal en bij 26 vrouwen (48%) was dit meestal nat. Deze laatste vrouwen hadden significant meer hinder en een significant lagere fysieke kwaliteit van leven dan de overige vrouwen.

CONCLUSIE
Bij de huisartsenpraktijk komt urine-incontinentie bij oudere, thuiswonende vrouwen veel vaker voor dan bij de huisarts bekend is. Dit duidt op onderrapportage. Een deel van de vrouwen ervaart ernstigere urine-incontinentie, waarvoor dagelijks opvangmateriaal nodig is en wat hinder geeft. Dit duidt op de noodzaak voor aanvullende diagnostiek en zo nodig behandeling.

Literatuur

  1. Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21:167–78.
  2. Teunissen T, Dekker JH, Lagro-Janssen LAM, et al. NHG-Standaard: Incontinentie voor urine bij vrouwen (versie 3.0). 2015. Te raadplegen op: https://richtlijnen.nhg.org/standaarden.
  3. Batmani S, Jalali R, Mohammadi M, et al. Prevalence and factors related to urinary incontinence in older adults women worldwide: a comprehensive systematic review and meta-analysis of observational studies. BMC Geriatr 2021;21:212.
  4. Milsom I, Gyhagen, M. The prevalence of urinary incontinence. Climacteric 2019;22:217-2.
  5. Bedretdinova D, Fritel X, Panjo H, et al. Prevalence of female urinary incontinence in the general population according to different definitions and study designs. Eur Urol 2016;69:256-64.
  6. Linde JM, Nijman RJM, Trzpis M. et al. Urinary incontinence in the Netherlands: prevalence and associated risk factors in adults. Neurourol Urodyn 2017;36:1519-28.
  7. Visser E, De Bock GH, Kollen BJ, et al. Systematic screening for urinary incontinence in older women: who could benefit from it? Scan J Prim Health Care 2012;30:21-8.
  8. Visser E, Dekker JH, Vermeulen KM, et al. The effect of systematic screening of older women for urinary incontinence on treatment uptake: the URINO trial. Maturitas 2013;74:334-40.
  9. Abufaraj M, Xu T, Cao C, et al. Prevalence and trends in urinary incontinence among women in the United States, 2005-2018. Am J Obstet Gynecol 2021;225:166e1-e12.
  10. Lee UJ, Feinstein L, Ward JB, et al. Prevalence and factors related to urinary incontinence in older adults women worldwide: a comprehensive systematic review and meta-analysis of observational studies. J Urol 2021;205:1718-24.
  11. Alshammari S, Alyahya M, Allhidan RS, et al. Effect of urinary incontinence on the quality of life of older adults in Riyadh: medical and sociocultural perspectives. Cureus 2020;12:e11599.
  12. Ramli MHT, Lodz NA, Aziz FAA, et al. Relationship between urinary incontinence and quality of life of older persons in Malaysia. Geriatr Gerontol Int 2020;20(suppl.2):38-42.
  13. Maeda N, Urabe Y, Suzuki Y, et al. Cross-sectional study of the prevalence and symptoms of urinary incontinence among Japanese older adults: associations with physical activity, health-related quality of life, and well-being. Int J Environ Res Public Health 2021;18:360.
  14. Cheng S, Lin D, Hu T, et al. Association of urinary incontinence and depression or anxiety: a meta-analysis. J Int Res Med 2020;48:1-12.
  15. Bulut TY, Altay B. Sleep quality and quality of life in older women with urinary incontinence residing in Turkey: a cross-sectional survey. J Wound Ostomy Continence Nurs 2020; 47:166-71.
  16. Murukesu RR, Singh DKA, Shahar S. Urinary incontinence among urban and rural community dwelling older women: prevalence, risk factors and quality of life. BMC Public Health 2019;19(suppl.4):529.
  17. Visser E, De Bock GH, Berger MY, et al. Impact of urinary incontinence on sexual functioning in communitydwelling older women. J Sex Med 2014;1:1757-65.
  18. Bezerra LRPS, Britto DF, Frota IPR, et al. (2020). The impact of urinary incontinence on sexual function: a systematic review. Sex Med Rev 2020;8:393-402.
  19. Pizzol D, Demurtas J, Celetto S, et al. Urinary incontinence and quality of life: a systematic review and meta‑analysis. Aging Clin Exp Res 2021;33:25-35.
  20. Lukacz ES, Santiago-Lastra Y, Albo ME, et al. Urinary incontinence in women a review. JAMA 2017;318:1592-604.
  21. Lane GI, Hagan K, Erekson E, et al. Patient-provider discussions about urinary incontinence among older women. J Gerontol A Biol Sci Med Sci 2021;76:463-9.
  22. Sullivan R, McNicholas T, Claffey P, et al. Unreported urinary incontinence: population-based prevalence and factors associated with non-reporting of symptoms in community-dwelling people ≥ 50 years. Eur Geriatr Med 2021;12:405-12.
  23. Moreira Vasconcelos CT, Veras Firmiano ML, Batista Oriá, MO, et al. Women’s knowledge, attitude and practice related to urinary incontinence: systematic review. Int Urogyn J 2019;30:171-80.
  24. Schreiber Pedersen L, Lose G, Høybye MT, et al. Predictors and reasons for help-seeking behavior among women with urinary incontinence. Int Urogynecol J 2018;29:521-30.
  25. Centraal Bureau voor de Statistiek (CBS). Personen met bij de huisarts bekende diagnose U04 Urine-incontinentie. Te raadplegen op: https://opendata.cbs.nl/#/CBS/nl/dataset/83110NED/table?ts=1614714101352
  26. Teunissen D, Van Weel C, Lagro-Janssen. Urinary incontinence in older people living in the community: examining help-seeking behaviour. Br J Gen Pract 2005;55:776-82.
  27. Visser E, De Bock GH, Messelink EJ, et al. Active encouragement of older women with urinary incontinence in primary care to undergo diagnosis and treatment: a matched-pair cluster randomized controlled trial. Maturitas 2015;80:212-9.
  28. Suskind AM, Dunn RL, Morgan DM, et al. The Michigan Incontinence Symptom Index (M-ISI): a clinical measure for type, severity, and bother related to urinary incontinence. Neurourol Urodyn 2014;33:1128-34.
  29.  Suskind AM, Dunn RL, Morgan DM, et al. A screening tool for clinically relevant urinary incontinence. Neurourol Urodyn 2015;34:332-5.
  30. Sargin MA, Yassa M, Taymur BD, et al. Adaptation and validation of the Michigan Incontinence Severity Index in a Turkish population. Patient Prefer Adherence 2016;10:929-35.
  31. Ware J, Kosinski M, Keller S. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 1996;34:220-33.
  32. Ware J, Kosinski M, Keller S. SF-12: How to score the SF-12 physical and mental health summary scales. 1995. Te raadplegen op: https://www.researchgate.net/publication/242636950
  33. Van der Zee KI, Sanderman R. Het meten van de algemene gezondheidstoestand met de Rand-36. Een handleiding. Tweede herziene druk. 2012. UMCG / Rijksuniversiteit Groningen, Research Institute SHARE.
  34. VanderZee K, Sanderman R, Heyink JW, et al. Psychometric qualities of the RAND 36-item Health Survey 1.0: a multidimensional measure of general health status. Int J Behav Med 1996;3:104-22.
  35. Gandek B, Ware JE, Aaronson NK, et al. Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA project. J Clin Epidemiol 1998;51:1171-8.
  36. Sanderson K, Andrews G. The SF-12 in the Australian population cross-validation of item selection. Aust N Z J Public Health 2002;26:343-5.
  37. Kontodimopoulos N, Pappa E, Niakas D, et al. Validity of SF-12 summary scores in a Greek general population. Health Qual Life Outcomes 2007;5:55.
  38. Shou J, Ren L, Wang H, et al. Reliability and validity of 12-item Short-Form health survey (SF-12) for the health status of Chinese community elderly population in Xujiahui district of Shanghai. Aging Clin Exp Res 2016;28:339-46.
  39. Guo X, Vittinghoff E, Olgin JE, et al. Volunteer participation in the Health eHeart Study: a comparison with the US population. Sci Rep 2017;7:1-9.
  40. Barentsen JA, Visser E, Hofstetter H, et al. Severity, not type, is the main predictor of decreased quality of life in elderly women with urinary incontinence: a populationbased study as part of a randomized controlled trial in primary care. Health Qual Life Outcomes 2012;10:153.
  41. Aguilar-Navarro S, Navarette-Reyes AP, Grados-Chavarría, et al. The severity of urinary incontinence decreases health-related quality of life among community-dwelling elderly. J Gerontol 2012;67:1266-71.
  42.  Kruht J, Gartner M, Mokris J, et al. Effect of severity of urinary incontinence on quality of life in women. Neurourol Urodyn 2018;37:1925-30.
  43. O’Reilly N, Nelson HD, Conry JM, et al. Screening for urinary incontinence in women: A recommendation from the Women’s Preventive Services Initiative. Ann Intern Med 2018;169:320-8.
  44.  Avery K, Donovan J, Peters TJ, et al. ICIQ: A brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn. 2004;23(4):322-330.
  45. . Meetinstrumentenindezorg. International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form (ICIQ-UI SF). Te raadplegen op: https://meetinstrumentenzorg.nl.
  46. Teunissen DTAM, Stegeman MM, Bor HH, et al. Treatment by a nurse practitioner in primary care improves the severity and impact of urinary incontinence in women. An observational study. BMC Urol 2015;15:51.
  47.  Lichtenstein BJ, Reuben DB, Karlamanga AS, et al. Effect of physician delegation to other healthcare providers on the quality of care for geriatric conditions. J Am Geriatr Soc 2015;63:2164-70.
  48.  Reuben DB, Ganz DA, Roth CP, et al. Effect of nurse practitioner comanagement on the care of geriatric conditions. J Am Geriatr Soc 2013;61:857-67.
  49. Holzer-Goor KM, Gaultney JG, Van Houten P, et al. Cost-effectiveness of including a nurse specialist in the treatment of urinary incontinence in primary care in the Netherlands. PLoS One 2015;10:e0138225.
  50.  Albers-Heitner P, Winkens R, Berghmans B, et al. Consumer satisfaction among patients and their general practitioners about involving nurse specialists in primary care for patients with urinary incontinence. Scan J Caring Sci 2013;27:253-9.
  51. Albers-Heitner CP, Lagro-Janssen ALM, Joore MA, et al. Effectiveness of involving a nurse specialist for patients with urinary incontinence in primary care: results of a pragmatic multicentre randomised controlled trial. Int J Clin Pract 2011;65:705-12.
Onderzoeksartikel

Hoge nood? Onderzoek in een huisartsenpraktijk naar urine-incontinentie bij oudere, thuiswonende vrouwen

DOEL
Het in een huisartsenpraktijk nagaan van de prevalentie, soort, ernst en hinder van urine-incontinentie en de invloed daarvan op de kwaliteit van leven van oudere, thuiswonende vrouwen.

METHODE
Thuiswonende vrouwen vanaf 60 jaar die op 9 juni 2020 stonden ingeschreven bij een huisarts in Grave werden gevraagd om een vragenlijst in te vullen. De aanwezigheid, soort, ernst en hinder van de urine-incontinentie werden uitgevraagd met de Michigan Incontinence Symptom Index (M-ISI) en de kwaliteit van leven met de 12-Item Short Form Health Survey (SF-12). Beschrijvende en toetsende analyses werden uitgevoerd om de uitkomsten te beschrijven en om subgroepen op basis van de soort en ernst van de urine-incontinentie te vergelijken op hinder en kwaliteit van leven.

RESULTATEN
Van de 216 aangeschreven vrouwen retourneerden 125 vrouwen (gemiddelde leeftijd 74 jaar) een ingevulde vragenlijst(respons 58%). Bij 54 vrouwen (43%) was sprake van urine-incontinentie: bij 13 vrouwen (10%) stressincontinentie, 14 vrouwen (11%)urge-incontinentie en 27 vrouwen (22%) gemengde incontinentie. Vrijwel al deze vrouwen (83%) gebruikten daarom opvangmateriaal en bij 26 vrouwen (48%) was dit meestal nat. Deze laatste vrouwen hadden significant meer hinder en een significant lagere fysieke kwaliteit van leven dan de overige vrouwen.

CONCLUSIE
Bij de huisartsenpraktijk komt urine-incontinentie bij oudere, thuiswonende vrouwen veel vaker voor dan bij de huisarts bekend is. Dit duidt op onderrapportage. Een deel van de vrouwen ervaart ernstigere urine-incontinentie, waarvoor dagelijks opvangmateriaal nodig is en wat hinder geeft. Dit duidt op de noodzaak voor aanvullende diagnostiek en zo nodig behandeling.

Literatuur

  1. Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21:167–78.
  2. Teunissen T, Dekker JH, Lagro-Janssen LAM, et al. NHG-Standaard: Incontinentie voor urine bij vrouwen (versie 3.0). 2015. Te raadplegen op: https://richtlijnen.nhg.org/standaarden.
  3. Batmani S, Jalali R, Mohammadi M, et al. Prevalence and factors related to urinary incontinence in older adults women worldwide: a comprehensive systematic review and meta-analysis of observational studies. BMC Geriatr 2021;21:212.
  4. Milsom I, Gyhagen, M. The prevalence of urinary incontinence. Climacteric 2019;22:217-2.
  5. Bedretdinova D, Fritel X, Panjo H, et al. Prevalence of female urinary incontinence in the general population according to different definitions and study designs. Eur Urol 2016;69:256-64.
  6. Linde JM, Nijman RJM, Trzpis M. et al. Urinary incontinence in the Netherlands: prevalence and associated risk factors in adults. Neurourol Urodyn 2017;36:1519-28.
  7. Visser E, De Bock GH, Kollen BJ, et al. Systematic screening for urinary incontinence in older women: who could benefit from it? Scan J Prim Health Care 2012;30:21-8.
  8. Visser E, Dekker JH, Vermeulen KM, et al. The effect of systematic screening of older women for urinary incontinence on treatment uptake: the URINO trial. Maturitas 2013;74:334-40.
  9. Abufaraj M, Xu T, Cao C, et al. Prevalence and trends in urinary incontinence among women in the United States, 2005-2018. Am J Obstet Gynecol 2021;225:166e1-e12.
  10. Lee UJ, Feinstein L, Ward JB, et al. Prevalence and factors related to urinary incontinence in older adults women worldwide: a comprehensive systematic review and meta-analysis of observational studies. J Urol 2021;205:1718-24.
  11. Alshammari S, Alyahya M, Allhidan RS, et al. Effect of urinary incontinence on the quality of life of older adults in Riyadh: medical and sociocultural perspectives. Cureus 2020;12:e11599.
  12. Ramli MHT, Lodz NA, Aziz FAA, et al. Relationship between urinary incontinence and quality of life of older persons in Malaysia. Geriatr Gerontol Int 2020;20(suppl.2):38-42.
  13. Maeda N, Urabe Y, Suzuki Y, et al. Cross-sectional study of the prevalence and symptoms of urinary incontinence among Japanese older adults: associations with physical activity, health-related quality of life, and well-being. Int J Environ Res Public Health 2021;18:360.
  14. Cheng S, Lin D, Hu T, et al. Association of urinary incontinence and depression or anxiety: a meta-analysis. J Int Res Med 2020;48:1-12.
  15. Bulut TY, Altay B. Sleep quality and quality of life in older women with urinary incontinence residing in Turkey: a cross-sectional survey. J Wound Ostomy Continence Nurs 2020; 47:166-71.
  16. Murukesu RR, Singh DKA, Shahar S. Urinary incontinence among urban and rural community dwelling older women: prevalence, risk factors and quality of life. BMC Public Health 2019;19(suppl.4):529.
  17. Visser E, De Bock GH, Berger MY, et al. Impact of urinary incontinence on sexual functioning in communitydwelling older women. J Sex Med 2014;1:1757-65.
  18. Bezerra LRPS, Britto DF, Frota IPR, et al. (2020). The impact of urinary incontinence on sexual function: a systematic review. Sex Med Rev 2020;8:393-402.
  19. Pizzol D, Demurtas J, Celetto S, et al. Urinary incontinence and quality of life: a systematic review and meta‑analysis. Aging Clin Exp Res 2021;33:25-35.
  20. Lukacz ES, Santiago-Lastra Y, Albo ME, et al. Urinary incontinence in women a review. JAMA 2017;318:1592-604.
  21. Lane GI, Hagan K, Erekson E, et al. Patient-provider discussions about urinary incontinence among older women. J Gerontol A Biol Sci Med Sci 2021;76:463-9.
  22. Sullivan R, McNicholas T, Claffey P, et al. Unreported urinary incontinence: population-based prevalence and factors associated with non-reporting of symptoms in community-dwelling people ≥ 50 years. Eur Geriatr Med 2021;12:405-12.
  23. Moreira Vasconcelos CT, Veras Firmiano ML, Batista Oriá, MO, et al. Women’s knowledge, attitude and practice related to urinary incontinence: systematic review. Int Urogyn J 2019;30:171-80.
  24. Schreiber Pedersen L, Lose G, Høybye MT, et al. Predictors and reasons for help-seeking behavior among women with urinary incontinence. Int Urogynecol J 2018;29:521-30.
  25. Centraal Bureau voor de Statistiek (CBS). Personen met bij de huisarts bekende diagnose U04 Urine-incontinentie. Te raadplegen op: https://opendata.cbs.nl/#/CBS/nl/dataset/83110NED/table?ts=1614714101352
  26. Teunissen D, Van Weel C, Lagro-Janssen. Urinary incontinence in older people living in the community: examining help-seeking behaviour. Br J Gen Pract 2005;55:776-82.
  27. Visser E, De Bock GH, Messelink EJ, et al. Active encouragement of older women with urinary incontinence in primary care to undergo diagnosis and treatment: a matched-pair cluster randomized controlled trial. Maturitas 2015;80:212-9.
  28. Suskind AM, Dunn RL, Morgan DM, et al. The Michigan Incontinence Symptom Index (M-ISI): a clinical measure for type, severity, and bother related to urinary incontinence. Neurourol Urodyn 2014;33:1128-34.
  29.  Suskind AM, Dunn RL, Morgan DM, et al. A screening tool for clinically relevant urinary incontinence. Neurourol Urodyn 2015;34:332-5.
  30. Sargin MA, Yassa M, Taymur BD, et al. Adaptation and validation of the Michigan Incontinence Severity Index in a Turkish population. Patient Prefer Adherence 2016;10:929-35.
  31. Ware J, Kosinski M, Keller S. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 1996;34:220-33.
  32. Ware J, Kosinski M, Keller S. SF-12: How to score the SF-12 physical and mental health summary scales. 1995. Te raadplegen op: https://www.researchgate.net/publication/242636950
  33. Van der Zee KI, Sanderman R. Het meten van de algemene gezondheidstoestand met de Rand-36. Een handleiding. Tweede herziene druk. 2012. UMCG / Rijksuniversiteit Groningen, Research Institute SHARE.
  34. VanderZee K, Sanderman R, Heyink JW, et al. Psychometric qualities of the RAND 36-item Health Survey 1.0: a multidimensional measure of general health status. Int J Behav Med 1996;3:104-22.
  35. Gandek B, Ware JE, Aaronson NK, et al. Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA project. J Clin Epidemiol 1998;51:1171-8.
  36. Sanderson K, Andrews G. The SF-12 in the Australian population cross-validation of item selection. Aust N Z J Public Health 2002;26:343-5.
  37. Kontodimopoulos N, Pappa E, Niakas D, et al. Validity of SF-12 summary scores in a Greek general population. Health Qual Life Outcomes 2007;5:55.
  38. Shou J, Ren L, Wang H, et al. Reliability and validity of 12-item Short-Form health survey (SF-12) for the health status of Chinese community elderly population in Xujiahui district of Shanghai. Aging Clin Exp Res 2016;28:339-46.
  39. Guo X, Vittinghoff E, Olgin JE, et al. Volunteer participation in the Health eHeart Study: a comparison with the US population. Sci Rep 2017;7:1-9.
  40. Barentsen JA, Visser E, Hofstetter H, et al. Severity, not type, is the main predictor of decreased quality of life in elderly women with urinary incontinence: a populationbased study as part of a randomized controlled trial in primary care. Health Qual Life Outcomes 2012;10:153.
  41. Aguilar-Navarro S, Navarette-Reyes AP, Grados-Chavarría, et al. The severity of urinary incontinence decreases health-related quality of life among community-dwelling elderly. J Gerontol 2012;67:1266-71.
  42.  Kruht J, Gartner M, Mokris J, et al. Effect of severity of urinary incontinence on quality of life in women. Neurourol Urodyn 2018;37:1925-30.
  43. O’Reilly N, Nelson HD, Conry JM, et al. Screening for urinary incontinence in women: A recommendation from the Women’s Preventive Services Initiative. Ann Intern Med 2018;169:320-8.
  44.  Avery K, Donovan J, Peters TJ, et al. ICIQ: A brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn. 2004;23(4):322-330.
  45. . Meetinstrumentenindezorg. International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form (ICIQ-UI SF). Te raadplegen op: https://meetinstrumentenzorg.nl.
  46. Teunissen DTAM, Stegeman MM, Bor HH, et al. Treatment by a nurse practitioner in primary care improves the severity and impact of urinary incontinence in women. An observational study. BMC Urol 2015;15:51.
  47.  Lichtenstein BJ, Reuben DB, Karlamanga AS, et al. Effect of physician delegation to other healthcare providers on the quality of care for geriatric conditions. J Am Geriatr Soc 2015;63:2164-70.
  48.  Reuben DB, Ganz DA, Roth CP, et al. Effect of nurse practitioner comanagement on the care of geriatric conditions. J Am Geriatr Soc 2013;61:857-67.
  49. Holzer-Goor KM, Gaultney JG, Van Houten P, et al. Cost-effectiveness of including a nurse specialist in the treatment of urinary incontinence in primary care in the Netherlands. PLoS One 2015;10:e0138225.
  50.  Albers-Heitner P, Winkens R, Berghmans B, et al. Consumer satisfaction among patients and their general practitioners about involving nurse specialists in primary care for patients with urinary incontinence. Scan J Caring Sci 2013;27:253-9.
  51. Albers-Heitner CP, Lagro-Janssen ALM, Joore MA, et al. Effectiveness of involving a nurse specialist for patients with urinary incontinence in primary care: results of a pragmatic multicentre randomised controlled trial. Int J Clin Pract 2011;65:705-12.
Over dit artikel
Auteurs
Suzanne van Kempen-van Es, Karin Walraven-Schils, Ercolie Bossema
Over de auteurs

Suzanne van Kempen-van Es is verpleegkundig specialist bij Buurtzorg Grave en Huisartsengroep Grave.
Karin Walraven-Schils is huisarts bij Huisartsengroep Grave.
Ercolie Bossema is hoofddocent en onderzoeker bij de Master Advanced Nursing Practice van de Hogeschool van Arnhem en Nijmege.

Correspondentieadres: ercolie.bossema@han.nl

Printdatum
11 maart 2022
E-pubdatum
14 maart 2022
ISSN print
0920-3273
ISSN online
2468-2225
DOI
https://doi.org/10.24078/vpg.2022.3.128645


Over dit artikel
Auteurs
Suzanne van Kempen-van Es, Karin Walraven-Schils, Ercolie Bossema
Over de auteurs

Suzanne van Kempen-van Es is verpleegkundig specialist bij Buurtzorg Grave en Huisartsengroep Grave.
Karin Walraven-Schils is huisarts bij Huisartsengroep Grave.
Ercolie Bossema is hoofddocent en onderzoeker bij de Master Advanced Nursing Practice van de Hogeschool van Arnhem en Nijmege.

Correspondentieadres: ercolie.bossema@han.nl

Printdatum
11 maart 2022
E-pubdatum
14 maart 2022
ISSN print
0920-3273
ISSN online
2468-2225
DOI
https://doi.org/10.24078/vpg.2022.3.128645