EPICCC-19: Exploring perspectives on COVID-19’s impact on continence care

Problems with bladder and bowel control (incontinence) are very common and affect people of all ages. Incontinence can be very socially and emotionally difficult. It can severely affect quality of life for those living with these challenges and their carers.

NHS community continence services assess and treat adults and children who are experiencing incontinence. The vast majority of bladder and bowel difficulties are treatable and can either be cured or improved using simple treatments delivered outside hospital.

Patients using continence services are often vulnerable, including children, older adults and people with learning disabilities.

Research has shown that well-organised continence services, based within the community and led by specialist nurses, are the best way to get good outcomes for patients and to save the NHS money overall. This is because when continence problems are treated early:

Further physical or mental health problems such as falls, urinary infections, anxiety and depression are prevented
Hospital admissions for these problems are avoided
Quality of life for patients and carers improves

The COVID-19 pandemic required changes to the way in which all NHS services were organised, including continence services. Changes included using phone assessments, usually via phone but also via video call, rather than face-to-face appointments. Some continence services stopped altogether.

This study is also known as the EPICCC-19 study. It is supported by the Elizabeth Blackwell Institute at the University of Bristol and NIHR ARC West.

What we did

We wanted to hear from community continence professionals about:

The changes to how services are delivered
The impact these changes had on how patients were cared for

To do this we sent an online survey to community continence services in England, and 65 services across all regions of England sent us answers to our questions.

What we found and what this means

We found that community continence services had moved to using remote or virtual assessments for a great many of their appointments, instead of face-to-face appointments.

The benefits of remote assessments were:

They allowed services to continue to provide continence care during the pandemic
They were reported to be particularly convenient and accessible for some patient groups
They could be less embarrassing for both younger and older patients, and made conversation easier
For some continence services, they allowed a more efficient use of time

However, physical examinations and routine tests could not be done during a remote appointment. This meant continence professionals had to decide which patients needed to be seen at a later in-person appointment.

Continence professionals’ concerns about remote assessments were:

Problems and diagnoses might be missed
The wrong care could be given
It could be more difficult to pick up on information that would keep patients safe
It was more challenging to build a therapeutic relationship between patient and professional
For some patient groups, access to and participation in remote appointments was particularly difficult

A third of services reported that staff had been moved to work in a different part of the health service (redeployment) or had patients added to their caseload that would normally have been looked after by another team.

Staff redeployment had resulted in long waiting times for many people living with continence problems, and some being left without care. Continence professionals perceived that continence care was undervalued. They called for greater recognition of its preventative role and potential to improve quality of life.

Paper

Paper:

Professional perspectives on impacts, benefits and disadvantages of changes made to community continence services during the COVID-19 pandemic: findings from the EPICCC-19 national survey

Read the paper

Lead collaborators

Dr Nikki Cotterill, Professor in Continence Care, Centre for Health and Clinical Research, University of the West of England (UWE Bristol)
Dr Cecily Palmer, University of Bristol
Professor Marcus Drake, University of Bristol
Davina Richardson, Bladder and Bowel UK
Juliette Rayner, ERIC

Partners on this project

Bristol Health Partners

Bristol Health Partners exists to help people in the Bristol, North Somerset and South Gloucestershire region live longer and healthier lives and improve how services are delivered. As an Academic Health Science Centre they integrate, promote and develop the region’s strengths in health and care services, research, innovation and education.

University of Bristol

The University of Bristol is internationally renowned and one of the very best in the UK, due to its outstanding teaching and research, its superb facilities and highly talented students and staff. Its students thrive in a rich academic environment which is informed by world-leading research. It hosts the Elizabeth Blackwell Institute for Health Research.

University of the West of England (UWE Bristol)

UWE Bristol is one of Britain's largest universities with a consistent reputation for high graduate employment, quality in teaching and growth in research. It is at the heart of dynamic partnerships that deliver real impact in the world. UWE hosts the Bristol Robotics Laboratory, the largest academic centre for multi-disciplinary robotics research in the UK.