Pelvic Health Case Studies

Living With have had a number of bladder and bowel service evaluations; three of them are brought together below with a summary of their findings.

Problem

Although pelvic floor muscle exercises are NICE recommended first-line treatment for women with stress urinary incontinence, and bowel retraining is a key part of specialised management for faecal incontinence, adherence is chronically low. Anecdotal clinical evidence from clinicians suggests that normal patient adherence to pelvic floor exercise programmes is less than 20%.

Furthermore, patients not following their treatment plans when they are out of hospital leads to more expensive treatment, including pads, meds and even surgery. Other impacts include:

• longer treatment pathways / escalating interventions
• increasing average number of appointments
• increasing DNAs
• appointment times longer than necessary

Solution

Living With Pelvic Health consists of a digital clinician dashboard and an outpatient app. The dashboard enables clinicians to monitor pelvic floor exercises, bladder and bowel diaries, and ICIQ outcomes on their patient’s Squeezy app—between appointments from the web-based dashboard. It is distributed to patients via a connected version of the Squeezy app (Squeezy Connect), which allows a service provider to make Squeezy available to all of its patients via a free download.

The Squeezy Connect app is designed to reduce patient worry, stress and anxiety, and to improve their understanding of their condition. It is also designed to support active self-management in the period between appointments through content and resources, and to improve motivation to follow the clinician-directed plans to achieve improved outcomes.

Outcomes

Detailed data from 3 NHS Trusts and several hundred patients provides clear evidence of the substantial quality and cost benefits that Living With Pelvic Health provides.

Patient outcomes

• Adherence to exercise programmes has increased from 21-23% to an average of 77%.
• Average ICIQ-SF score when patients get discharged improved from 7 to 5.
• Outcomes are at least 25% better for LWPH patients.
• Average ICIQ UI score improved from 9.8 in 12 months prior to using LWPH to 5.9 in subsequent 12 months.
• Positive results are irrespective of age: 14% of patients treated are over 65, and the oldest patient was 76 with 76% adherence to exercises.

Clinic outcomes

• LWPH delivers clinicians the new knowledge to enable them to focus on patients with the greatest needs, postpone non-compliant patients and deliver improved patient outcomes.
• Approximate annual cost savings of between £50,000 and £75,000 per Trust. Specific savings identified are:
  • reduction in DNAs: DNAs have decreased by 22% for patients using LWPH versus patients not using the app in the last 12 months. Each appointment saved is £66, total savings of £8,712.
  • Reduction in non-compliant appointments: In the 12 months before using LWPH the % of appointments lost as being non-compliant because patients were not doing their exercises was 16.2%. This has reduced to 4.6% for patients using LWPH.
  • Face to face appointments converted to telephone: Approximately 12.74% of appointments were converted to phone appointments. Each appointment saved at least £39, which equates to £3,276 in savings.
  • Reduction in appointments: Average number of appointments per patient from intake to discharge reduced from 7.4 to 6.1.
  • Average number of appointments per patient reduced from 6.2 to 4.4. Cost savings per patient are c. £78.30.
  • Reduction in surgery: Annualised savings of between £16,800 and £24,733.
  • Reduction in referral to first appointment times.
  • Shorter treatment cycles: Average treatment cycle reduced by 16.1%.