Background: Guidelines on urinary incontinence recommend that absorbent products are only used as a coping\nstrategy pending definitive treatment, as an adjunct to ongoing therapy, or for long-term management after all\ntreatment options have been explored. However, these criteria are rarely met and a significant share of long-term\nproduct users could still benefit from therapeutic interventions recommended in guidelines for urinary incontinence.\nBetter implementation of these guidelines can potentially result in both health benefits for women and long-term\ncost savings for society. The aim of the COCON study is to evaluate the (cost-)effectiveness of a nurse-led intervention\nto optimise implementation of guideline-concordant continence care in comparison with usual care for urinary\nincontinent women aged 55 years and over who use absorbent products.\nMethods: This randomised clinical trial compares usual care with a nurse-led intervention to optimise implementation\nof guideline-concordant continence care. Women (anticipated N = 160) are recruited in 12 community pharmacies in\nthree Dutch regions, and are eligible for trial entry when they are 55 years and over, community-dwelling and longterm\nusers of absorbent products (�4 months) reimbursed by health insurance. Measurements are administered at\nbaseline, 3, 6 and 12 months. Primary outcome is severity of urinary incontinence (ICIQ-UI SF); other outcomes include\nhealth related quality of life (EQ-5D-5 L), use of absorbent products (in accordance with the recommended criteria in\nguidelines) (yes/no), and societal costs. Mixed model analysis will be performed to compare (the course) of outcomes\nbetween groups. The economic evaluation will be performed from a societal perspective. The implementation process\nis investigated using the Tailored Implementation for Chronic Diseases (TICD) framework.\nDiscussion: Results will add to current knowledge of the (cost-)effectiveness of nurse-led primary healthcare to\nimprove guideline-concordant care for older women with urinary incontinence. In addition, the results will provide\nmore insight into care needs and health service utilization of this group of women, as well as into use of absorbent\nproducts in accordance with the recommended criteria in guidelines. Finally, results will increase our understanding\nof the intervention�s uptake and could provide useful insights for future dissemination and sustenance.
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