Provision of continence pads by the continence services in Great Britain: fair all round?

Purpose: The UK Department of Health guidelines for continence services recommended that maintenance products should be available to anyone in quantities appropriate to the individuals' needs and to children above the age of 4 years. Despite this, there is much anecdotal evidence of rationing products. The aim of this study was to examine to what extent services limited pad supplies and what criteria were in operation to govern the supply.

Methods: A questionnaire exploring the current practice in conferring eligibility and prescribing and providing continence products was developed and distributed to all continence services in Great Britain, using a database of services. Data were analyzed from all returned questionnaires to all continence services on the Continence Foundation database and were also extracted from the 2006 National Audit of Continence Care for Older People.

Results: Few continence services employed clear and detailed criteria for issuing continence pads and, when present, written criteria used arbitrary cutoffs for measuring incontinence severity. Rationing was widespread, and the most common adult pad allowance was 4 per day. In addition, 59% of continence services provided pads to children below the recommended age of 4 years.

Conclusions: Distribution of continence pads was based upon arbitrary criteria. We recommend the development of a single assessment tool with clear criteria for provision of continence products throughout the United Kingdom. We also recommend that criteria limiting the number of continence pads supplied on a daily basis are transparent and explicit.