Stop the Leaks! Improving Health through Better Incontinence Care at Home

Incontinence can be challenging for almost anyone, and it can be particularly difficult for frail, older patients as well as those on Medicare and Medicaid.  Today's guests are here to let you know that it doesn't have to be. 

They're here to give us a sneak peek into a soon-to-be-published study that patients, physicians and caregivers can all take comfort in, because it demonstrates how an easy-to-implement program can generate significant symptom improvement and dramatically increase quality of life for incontinence sufferers. 

For more than twenty years, Tenderheart Health Outcomes has been offering personalized incontinence coaching, high-quality products and close, personal support for members of the incontinence community. Now they've partnered with researchers from the Perelman School of Medicine at the University of Pennsylvania and the University of Minnesota to evaluate the effectiveness of a program that combines expert coaching, basic behavioral modifications, simple lifestyle changes and the use of appropriate absorbent products to generate measurable results in a population where effective treatments are often hard to come by. 

It's a fascinating and important conversation with Tina Harris from Tenderheart, Dr. Diane K. Newman from the University of Pennsylvania, and Dr. Kristine Talley from the University of Minnesota. 

You can also learn more by visiting Tenderheart online at https://www.tenderheart.com/about-us/news-and-research/ or calling 877-394-1860.

For more information about the National Association for Continence, click here, and be sure to follow us on Facebook, Instagram, Twitter and Pinterest.

Music:
Rainbows Kevin MacLeod (incompetech.com)
Licensed under Creative Commons: By Attribution 3.0 License
http://creativecommons.org/licenses/by/3.0/

TenderHeart Health Outcomes offers individualized care plans and superior products to meet your unique needs.  Their coaching focuses on asking the right questions, and their high-quality products prevent leaking, are comfortable and skin friendly. Plus, their trained staff focuses on your individual needs. Your total satisfaction is their goal and healthy living is their mission. Learn more at www.tenderheart.com or call 1-877-394-1860 today.</

Transcript

The following transcript was generated electronically. Please let us know if you see any transcribing errors and we'll get them corrected immediately. 

Bruce Kassover: Welcome to Life Without Leaks, a podcast by the National Association for Continence. NAFC is America's leading advocate for people with bladder and bowel conditions, with resources, connections to doctors, and a welcoming community of patients, physicians, and caregivers. All available at nafc.org. 

Welcome back to another episode of Life Without Leaks. I'm your host, Bruce Kassover, and joining us today is Sarah Jenkins, the executive Director for the National Association for Continence. Welcome, Sarah. 

Sarah Jenkins: Thanks Bruce. I'm so excited for this discussion today. 

Bruce Kassover: Yeah, I am too. This one is going to be a little different than our typical podcast. Normally it's just us talking one-on-one with a guest, but we actually have a few people joining us today to talk about a pretty important effort.

So our first guest is Tina Harris. She is the Vice President of Clinical Affairs at Tenderheart Health Outcomes where she leads clinical monitoring and provides oversight to patient engagement teams. She focuses on things like optimizing clinical workflows and ensuring high quality coordinated care for patients and everyone else. So welcome, Tina. Thank you for joining us. 

Tina Harris: Thank you. Glad to be here, Bruce. 

Bruce Kassover: Awesome. Also on the podcast is Dr. Kristine Talley. She is a nationally recognized distinguished educator in gerontological nursing and an associate professor and co-director of the Geriatric Workforce Enhancement Program at the University of Minnesota. So welcome, Dr. Talley. Thank you for joining us today, too.  

Dr. Kristine Talley: Welcome. I'm also excited to be here to talk about this topic today. 

Bruce Kassover: And our third guest is Dr. Diane Newman. She is a nationally recognized expert in urology nursing, and continence care, and she brings more than 30 years of clinical experience. She's practicing right now at Penn Medicine where she serves as an adjunct professor of surgery at the Perelman School of Medicine at the University of Pennsylvania. So welcome, Dr. Newman. Thank you for joining us. 

Dr. Diane Newman: Oh, thank you very much for having me, and I'm just honored to be able to talk about this topic with NAFC. 

Bruce Kassover: Yeah, we're really looking forward to it. We think that our patients are going to get a lot out of it, not just the listeners who are patients, but also clinicians and everybody involved with the healthcare field when it comes to dealing with urological issues. So, Tina, maybe you want to start us off by telling us a little bit about what we're going to be discussing today?

Tina Harris: Yeah, it's just been a pleasure working with both Diane and Kristine on this topic. Just a little background here. Tenderheart is a value-based incontinence management solutions company, so we support primarily the Medicaid market in helping manage incontinence care at home. Our particular focus is to give quality products to the patients and also make sure that they get coaching and education that they can then use to care for themselves at home. So, we were super excited to partner with the University of Minnesota and the University of Pennsylvania.

Today we're going to share some insights from a study that we did regarding the Medicaid population and just some interesting facts that we found out about behaviors, about positive outcomes for the patient, and so that's why we decided to seek out some really heavy weighted partners here to help us study this population.

Dr. Diane Newman: You know, I think that the audience probably knows is that the use of absorbent pads are just so helpful for individuals to manage urine leakage. But there's so very little research on what do people use? What's the best product? Are they…? And I think what was so exciting about this research, and what Tina and her group at Tenderheart has done is really develop, wanted to test a program where we really try to learn what is the best product for that individual and what else can they do to maybe, possibly manage or even decrease their incontinence.

Dr. Kristine Talley: Yeah, I would just like to add that as a researcher, I've done clinical trials to help improve incontinence in frail, older women, particularly, and they're an extremely hard group to recruit and get access to, and so I was very excited to join this partnership because with the contracts through Tenderheart, they have access to Medicaid patients who actually have incontinence. And so honestly for me, it was one of the easiest ways to access this patient population to help improve their incontinence. 

Bruce Kassover: This is a pretty, it's a pretty important demographic that we're re we're reaching out to on a pretty important topic. Was there not a lot of research ahead of time that already existed?

Dr. Diane Newman: You know, there's very little research in this area. First of all, like Kris said, this population is frail, disabled, receiving, you know, other services and it has a high prevalence of urinary incontinence. They probably have difficulty getting to a physician, even if they would seek out help for their incontinence. So this is a population needs to be studied, but there's so very little research on it and it's basically because they're hard to reach, I think. Right?

Tina Harris: And also, Diane. You know, unfortunately the healthcare industry isn't interested in something as simple as incontinence care. But it actually isn't simple; it feeds in a large financial cost, not only to the healthcare system, but also to the patient's lives. So, there's not a lot of focus on incontinence care as an important part of the patient's care plan. 

Dr. Kristine Talley: Right. Another thing I'd like to point out too, well, there has been quite a bit of research done on frail older people who are in nursing homes. Very little is done on frail, older people who are living in the community. What's exciting about this project is the people that we targeted are, a lot of them actually are nursing home-eligible but are still living in the community. And so, this was just a great way to access this population that needs a lot of help in this area. 

Bruce Kassover: So we have our demographic and we have a general idea that we're going to be talking with them to learn more about incontinence. Was there a particular overriding research question or group of research questions that really shaped how you were reaching out to them and what you were looking to find? 

Tina Harris: Yeah. One of the things is that we wanted to test out Tenderheart's model. We are very unique in providing high quality products and frequent touchpoints to patients that involve providing care coaching for them, and so we wanted to see the impact not only clinically in regards to their conditions, but also how they felt about it. We also studied the financial cost of having to, and a lot of listeners may be buying products out-of-pocket. So, we wanted to identify what's the cost associated with that? Are people aware that Medicaid, if they're eligible for Medicaid, that Medicaid covers those things? 

Dr. Kristine Talley: Another novel part of this program or this investigation, actually, is we actually don't know what kind of pads and products this population or any population for that matter is using. And so that's also new information that we're receiving about what are people using and how are they using it. And that's really important for us to understand because in many states, the Medicaid programs pay for these products, right? So, we want to make sure that people are getting the right product for them, and that we can understand how much product people need so that honestly, in the future, Medicaid programs can anticipate this potential cost that they're required to cover.

Tina Harris: Also consideration for Medicare recipients as well. Medicare doesn't typically cover absorbency products, but the age group for incontinence is eligible for Medicare, and so hopefully this study and more studies to come will help also provide support for potential coverage in the Medicare market.

Dr. Diane Newman: The other thing that I think is interesting that we have no understanding of is, we may have certain categories of products, and actually the International Incontinence Society has terminology to describe what these different products, like protective underwear or pull-ups, or adult briefs or adult diapers.

And what we really find is that there's like four, it could be on as much as six levels, you know, long ones, light absorbency, heavy absorbency. And I want you to know that Tenderheart, really try to, you know, get down to the, “Which exactly product do you need and which works for you?” Like maybe at night when you have heavier leakage, you need a heavier type of product or a different, you know, material or whatever.

So I think there's nothing that really knows what people are doing, what is real-world use of these products? And I think that this, that addition to the literature and to the understanding, I think, is really, really important. 

Dr. Kristine Talley: I will also just add to that, that looking at the pad usage over time, we actually saw over time that patients were using lower absorbency products, so we were seeing a real shift in to more appropriate product use.

Tina Harris: One thing that we didn't point out was that there's a lot of waste that happens with absorbency products. Most DME providers are just shipping the max allowable that will be paid out even though the patient may only need half of that. So, what happens is they end up throwing them away or they end up selling them in a flea market or you know, at a swap shop. And so that's an important piece too, is just to make sure that we're getting the right quantities and that we're not just shipping out product just because we're going to get paid for that. We have to think about the quality of the patient and begin to provide individualized care for each one.

Bruce Kassover: That makes perfect sense. One of the things that I think Sarah can really talk about is how, for ages, NAFC has been focused on trying to bring clarity to the idea of absorbent product standards and what, how you choose them and what does it mean to have something that's extra absorbent or less absorbent and all of those sorts of things.

Sarah, maybe you could talk a little bit about how the NAFC is working to bring a little bit more clarity to that?

Sarah Jenkins: Sure, I'd be happy to. NAFC has worked for over 10 years to develop a set of quality absorbent standards for absorbent products. And you know, we've worked with manufacturers and healthcare professionals and managed care plans to really determine what the best approach is for this. And our current standards actually measure across a variety of different things like elasticity and re-wet rate and absorbency rate, and all the different things that go into making a good quality absorbent product. And we've developed these standards and have a lot of effort into getting them approved on state Medicaid plans so that long-term care facilities and patients on Medicaid can receive the highest quality product for them, not just the least expensive. 

Dr. Kristine Talley: I'd also just like to say that one of the main outcomes that we're also interested, besides just the impact of Tenderheart’s program, but also looking at patient reported outcomes.

So we're looking at how, did patients report an improvement in their incontinence? Did they report an improvement in their quality of life related to incontinence, but also quality of life overall? And also looking at their satisfaction with the program and engagement with the program, 

Bruce Kassover: And what results did you find?

Dr. Kristine Talley: Well, that's the exciting part for me. So I'll start with the clinical outcomes that we found. We saw clinically meaningful improvements in urinary incontinence using a questionnaire called the ICIQ, which is standardly used in almost all incontinence research. And you know, it's worth saying that this group of people started out with quite severe incontinence, and we actually were able to improve their incontinence almost 30%, almost 40%. 

But the clinically meaningful difference, it actually exceeds what we see for most conservative interventions. So, we were very excited to see an improvement in incontinence, a measure that we use in research. Also though, 66% of participants reported that, “Hey, my incontinence got better, or much better.” So two thirds saw an improvement. Only 5% saw said at the end of the program that their incontinence was worse. 

So those are great clinical outcomes for that, but also really importantly was the quality of life. So we used a measure called the Incontinence Impact Questionnaire. Again, we saw statistically and clinically meaningful improvements in their urinary incontinence-related quality of life, and we also saw statistically and clinically significant improvements in their health-related quality of life measured with a very general measure called the EQ-5D-5L, and again, these clinically important improvements are very meaningful, especially since these were people with relatively low quality of life, whether it was related to their incontinence or general health quality of life, and then also their severity of incontinence.

So we hit a really high-risk group and we're able to get improvements for them clinically that were clinically meaningful. 

Dr. Diane Newman: Yes, and I think that everything Kris said shows that we really made an impact. And again, I want to stress to our viewers that this is in a very difficult group to see an impact.

Like she said, they were frail, disabled, many were using assisted devices. So the point is that we are really excited about this data, and I want to stress to you, too, that when I said ‘behavioral treatments,’ these are really education, teaching them what to do with a lot of different areas, you know, bowel function and that.

And NAFC has these resources. What we use is not some, kind-of, just in research or whatever; they're available. And I want to stress that because, you know, Sarah, you guys have some great educational tools there. We utilize those and that's what was a lot of our education program. We taught at Tenderheart individuals who talk with these patients or these clients within this program and go through with them some of these behavioral treatments on the phone. So, it was really, to show this type of impact, I think, is really quite significant. 

Tina Harris: The other part, the last part of that is the satisfaction from the program as well. That was really high. As we went toward the end of the program, the majority of the folks, the high 90s, I don't think we had anyone that was dissatisfied with the program by month nine, which was the completion of the study.

So that's also important for, you know, health plans and providers and patients to know. That there is some satisfaction there, there is some level of improvement that patients are receiving from this type of program. 

Bruce Kassover: Now you have me really intrigued because you're talking about the behavioral things and the educational things that made up the program. But if I'm somebody who, either a patient myself or a caregiver of a patient, do you have any more details or can you share any more details about what the program specifically, really looked like? What took place in the program to generate that sort of improvement? 

Tina Harris: Sure. I'll start off. So, like Diane mentioned, we used what we consider layman's people. They're not clinicians at all. And so, one is that anyone can be taught in regards to providing the information. 

So we use our utilization management team. Their number one responsibility is to outreach to members and to provide that coaching. So we did a nine-month study with the six months of intervention, discussing topics like skin health and falls and different areas that are important for someone to be able to manage their incontinence at home. Kris mentioned patient reported outcomes, so we collected information from the patient as well. Their usage of the product, again, their satisfaction, any health conditions that they had.

So that was the, the gist of the study from month one to month six, and then six to nine, we just talked to the member, gathered additional information and then ended the study With that. Kris and Diane, I know you have more to add there. 

Dr. Diane Newman: Well, and you know, it's everything that Tina said, and I want to stress that Tina had, kind-of, this program in place, and she saw the benefit as far as not just, you know, patient satisfaction, better use of absorbent products from urine leakage, but also cost savings.

I think that's a key thing that we really haven't talked about yet. And the point is, is that we, you know, when she presented this to us, Kris and I got our heads together and we decided to enlarge on it a little bit. So the basis of this program had been used by Tenderheart. We just defined it a little bit better, made sure that we had all the behavioral interventions for urine leakage covered, you know, such as bowel function, diet, fluid, and that type of thing.

So what we did is, we kind of made a more robust intervention with her clients – but I want to stress that this was a basis that Tenderheart had been doing and they themselves saw, “Hey – we're seeing improvement in this, we're controlling costs and we're giving better care and better management of incontinence.

Dr. Kristine Talley: I'd like to point out that, so this was all telephone coaching done by the lay people. I also just want to stress how innovative this approach is and the access that it gives people. 

First of all, a lot of people don't even know what conservative treatments are available. And even if they do know it, they may not be able to access it for many reasons. They may have transportation issues getting to a clinic if they're lucky enough to find a continence specialist that can help them. But also, continence specialists are hard to come by and challenging to find. And so, this offered a telephone coaching where they could access someone who could coach them through these conservative, you know, lifestyle and behavioral treatments that a lot of people can learn also through self-management. In a way, this coaching was helping people self-manage their symptoms as well as getting expert consultation on the right products to use. 

Dr. Diane Newman: Yeah, and you know, Kris brings up important point, and I'm really embarrassed to say this as a specialist, a clinician who's been practicing for years in this field, but when we, you know, when a lot of us, you know, urologists, physicians, nurses, nurse practitioners, physician assistants, see these patients, I don't think that a lot of people really ask about how are they containing or managing their urine leakage. You know, we're very quick to say, “Okay, now we have medications that might help you. I don't know, maybe there's some kind of surgical intervention that might help you, but we really don't get down to, well, how do you live day to day with this? You know, what are you using?” 

And you know, I think, Bruce, you brought up about caregivers. We do know whether we were talking directly to that individual who's insured in Medicare or whether it is a caregiver, so that we know who's really providing some of the information that we need. But who is really involved in that care? Because it's true that a lot of individuals at this level really do need caregiving, need assistance to walk to the bathroom, to even maybe wipe themselves. 

So, you know, we don't do a good job even when they come in, Kris. You're right. I mean, most people don't come forward do they? Especially older, frail individuals. They just, “Oh, I'm going to live with this. Oh, I'm, you know, I can't walk that far.” 

Tina Harris: It’s the stigma, right?

Dr. Diane Newman: Yeah, the stigma, right.

Tina Harris: And then a lot of times members don't know what questions to ask. They think that incontinence is just a normal part of aging because it's so common, and it's not a normal part of aging – but it is common, and there are ways that you can manage it at home.

So you're exactly right, both Kris and Diane, that, you know, there's a stigma there that prevents folks from being able to engage their care providers to even have a conversation about it. And so Tenderheart and models like this can help support patients; if they're not comfortable talking to their physician, you know, we can give them tips to talk to that physician and say, “You know, this is specifically what I'm struggling with,” right?

And ask the right questions. And so, NAFC also has resources as well on how to speak to your doctor or even caregivers to speak to other family members about the incontinence care that's needed. So yeah, very important. 

Dr. Kristine Talley: 28% of our participants were actually receiving home health services. So even people who were receiving home health services still felt they had a need to improve their incontinence and found this project, the study, appealing to be in.

Sarah Jenkins: That's great, and this is all such good information and I think empowering for patients to know that they actually can take this on themselves and with, you know, behavioral changes, make a huge difference like this. 

I'm curious to know, did any specific behavioral techniques stand out as being more helpful than others in the study? Did you see more success with one over another, or was it more of a combination of things that folks tried? 

Dr. Diane Newman: You know, Sarah, that's a great question, because you know, being a researcher and in behavioral therapy, I'm always asked, “Well, was it the toileting program? Was it the decrease of caffeine, which is a lifestyle change, work?”

You know, the issue with behavioral therapy, it's really a combination of all of them, and so that's how we approached it. Every week they were counseled on a different component of behavioral therapy because a lot of us who have been in this field a long time feel that it's more of the combination of all of the different behaviors.

You know, and I'll say this, I'm not a believer that it's just your pelvic four muscle exercises. It's just not the pelvic four muscle strengthening that really will control your urinary symptoms. I personally feel it’s sometimes the bladder retraining, and we had one week where they talked about bladder retraining and how to control urgency.

So you know, Sarah, you know, I'm kind of a purist in the sense it's a combination of all the behavioral interventions. I don't know, Kris, if you feel differently about that. 

Dr. Kristine Talley: No, I feel the same. And also, the important thing about this is that the coaching was also very tailored to what the participant wanted to work on or had the ability to work on. And honestly, in multi-component intervention research studies, it's extremely hard to tease out which component worked. And so far, no one has even done that in incontinence research today. 

Tina Harris: Yeah, and that's our focus. It's a combination of our coaching and also the high-quality products that create the effect that we have, and whether or not it's, you know, to Kris's point, there's research in whether one over the other works. What we do know is that both of them together work and that it's providing a service to the incontinence population.

Dr. Diane Newman: Well, one of the things that Tenderheart was good about is, we factored into this research that what individuals do during the day may not be what they do or need at night. One of the biggest problems with the frail elders or with aging is falls, usually at night.

And what the event that's happening is, they're trying to access the bathroom and they trip over a carpet, or it's dark and they run into something. I can't tell you how many individuals I would see who ended up in a rehab center, and I looked at their notes, they slipped on urine in the bathroom at night where they just couldn't make it to the toilet without having an accident.

And the thing is that what we try to determine and what the Tenderheart kind of algorithm is, you know, what do you need depending on what you're doing and what time of day. And I think that's an important thing. Individuals do not just use one pad for the whole day. Maybe they just need it at night. Maybe they just need it during certain times during the day. The research did look at that, and the use of products was dependent on events as far as time of the day. 

Tina Harris: I was going to say, Diane, you mentioned the different types of coaching pieces that we did. A good thing here as well is that sometimes there are misconceptions about how to care for your incontinence.

So, for example, patients will think that if I don't drink anything, then that will keep me from having the incontinence or the severity. And that's not true. It actually will make it worse. Some folks aren't aware that there's medications like diuretics that can cause their incontinence to be worse. And so, in having that teaching program in place, we're able to debunk those myths that patients have picked up along the way and orient them to the appropriate care for them.

Bruce Kassover: It sounds to me like what you're talking about, the program that you're describing is not like we're introducing something that's novel or something that's maybe in a sort-of undiscovered to… it's really just sort of validating what happens when you try to address incontinence the correct and the proper way.

That is, when you introduce an absorbent program that is built around the individual's needs, when you help them understand what sort of behaviors can contribute to incontinence and what sort of behaviors can help lessen the episodes of leakage, when you remind them of things like, this is how you eat, this is how you can do, you know, pelvic floor exercises, and this is how you can care for your skin and for your bedding and, well, when you do everything the right way, then you're going to get really good outcomes. Is that a fair assessment or am I missing something? 

Dr. Kristine Talley: I would say that's a fair assessment, but also, you know, we know these things work. Our issue is, how do we let people know these work? How do we get to these people? How do we get people to implement these things? And I think that's the innovation of this, is the way we delivered it through telephone coaching, through a product supplier. So, you don't have to go to a clinic or find a continence nurse specialist, which may not be available. So, I think the innovation here really is in increasing access to what we know works. 

Tina Harris: And it also sheds light in the community realm, the healthcare realm for health plans and providers, that there is a way to help manage this population because there again, not a lot of focus on this particular condition or the population in general.

These are things that can be easily picked up, either just partnering with Tenderheart or creating something singular on your own. But the great thing is that now healthcare providers have heard patients' responses to telephonic counseling programs. And hopefully they will look at their own programs, partner with their quality management teams and provide some level of collaboration to support this member base more.

Dr. Diane Newman: Bruce, this really is novel. I don't know of any researcher or anyone who, where you have someone who's a company of a medical supplier that can supply these products, say, “Hey, I think we can do this better,” in such a population. I really have, I don't know of any… Kris, you may, may know some; I don't know of any in the United States where this has been tried. So, in that sense, this is very, very much a novel program. 

Bruce Kassover: That's outstanding. So, if I happen to be either a caregiver or a patient, what can I take away from this study right now? What would your recommendation be? 

Tina Harris: So, there's actually a couple, if you'll allow me to go through those. One is that you're not alone when it comes to managing incontinence at home. It is very much a condition that you can independently manage. 

So, one would be to know that you're not alone, right? Break the stigma of it being an embarrassing condition to discuss. The second thing is to know the resources that you have. So again, NAFC has resources. Tenderheart Health has resources, as well. Talk to your provider. We can provide support for, you know, giving questions that you should ask the provider, whether you're a caregiver or the actual patient, and being able to manage the care. 

And then the last thing is, know the coverage, as well. So, we talked about before that a lot of folks are paying out-of-pocket. Some of your listeners, maybe 80% of those are paying out-of-pocket for those services, and there could be some coverage under Medicaid or another plan that could help, you know, offset some of the costs of their absorbency products. 

So, those would be the things that I've would leave specifically for the study. You're not alone. You can manage this at home. There are services that can support you being able to take care of yourself independently.

Talk to your physician about incontinence. Make sure that you're on a good treatment plan. Tenderheart does not treat incontinence, but we provide solutions for people who do have incontinence. And then, also, just making sure you know what your resources are, know if there's coverage available for absorbency products, and just reach out and know who is available to support you and your care.

Bruce Kassover: You know, that's a perfect segue to actually ask you for a little more information about Tenderheart, about how you work with patients, help them in terms of affordability and the product selection and, you know, how people can take advantage of the services that you guys offer. 

Tina Harris: Yeah, absolutely. The bigger part of our program is the collaboration with health plan partners, so Medicaid Managed Care Organizations who are supporting this population. But we also have self-pay. We also have Medicare patients. The best way to get in contact with us is either to call our free number [877-394-1860], which will, you'll see that here in the podcast. You can also submit a referral if you're a service coordinator or a healthcare provider to our online portal, and we can start services that way. We also have email [help@tenderheart.com] as well, or you can fax a request to us, and that's what we'll get the ball rolling on being able to do an individual assessment. 

Typically, we talk to the members individually because it's not a cookie cutter approach, so I want to make sure that as folks are reaching out, we tailor to the individual. Everybody's condition is not the same, and so we want to make sure we get that one-on-one time with them. So reach out to us via our website, via our toll free number, via a healthcare provider, you can send us a fax [866-897-5881] or an email and we will take it from there, Bruce. 

Bruce Kassover: So then we'll make sure to put the contact information, the phone number in the website, in the show notes, so anybody can click and call. But now, if I'm not a patient, but if I am a physician or a clinician, is this study available yet? Is it in pre-print or has it been published, or when is it coming out? 

Tina Harris: Yeah, great question. So, Kris gave you some of the preliminary analysis that we've done. In July, which is in just a week or so, we expect to have the final results. We will be presenting that publicly. All of us have different platforms that we'll be presenting on, but throughout the summer and the fall, we will be doing some public presentations as well. We're not sure exactly when it will go into print. There's a lot of backend things that we have to get reviewed before it goes publicly, but we will have presentations available shortly. 

Bruce Kassover: It's outstanding. I look forward to it. That's going to be great. Well, as you know, this is Life Without Leaks, and one of the things that we'd like to do before we leave is to provide our listeners with one little hint, tip, strategy, bit of advice to help them live a life without leaks. So, Tina, I'd like to turn to you and see if maybe you have one you could share with the group today.

Tina Harris: Yeah, I think I may have mentioned it a little bit earlier, but you're not alone when it comes to incontinence, and it is a condition that you can manage successfully at home, connect with the right people, whether they're in your community or it's a provider or if it's Tenderheart or even just your service coordinator. If you have a managed care provider and talk to them about incontinence so that they can help you get the support that you need.

I wanted to, you know, also encourage healthcare partners to be more aware about incontinence, think about the quality of care as you're thinking of programs or innovative ways to support this population. Think about conditions that actually lead to more adverse things if they're not managed appropriately and take the time – I know in healthcare, there's so many priorities that we have – but just take the time to understand the population and don't overlook those seemingly small conditions that can lead to be bigger problems later on in the patient's life. 

Bruce Kassover: That's so true, and it's so important, and you know, it still to this day, I find it a little surprising how many people in the healthcare industry don't realize that, you know, continence care and care for the pelvic floor is basic, essential healthcare as much as almost any other question they're asking in the diagnostic process. I mean, this stuff should not be ignored for whatever reason, because it's icky or because it makes your patients uncomfortable or you don't feel comfortable enough yourself with it. So absolutely, I love hearing that and we hope that the people do following this advice completely. 

Dr. Kristine Talley: Can I also add about providers and stigma and preconceptions about what frail older people are capable of? I think that this also can help alleviate some providers’ concerns that well… they're not able to follow through, they're not able to do this, and that simply isn't the case. There's always opportunity and ability of even frail people to be able to improve this through, you know, basic self-care and good standard management. 

Tina Harris: I love that, Kris, because a lot of times, you know, there's surgical interventions and different things that you can do, and a person may be too old where the provider isn't comfortable doing that, but there are alternative treatments like using absorbency products correctly. 

Bruce Kassover: Great advice, and I hope that everybody takes you up on it. I also hope that everybody really takes to heart the lessons that this research is showing, which is if you do the right things, if you make it your job to educate yourself, if you make it your job to find the right absorbent products, if you make the effort to address your behaviors and you don't let the stigma get to you, then you really can see a massive improvement in your quality of life, in the reduction of episodes, all of those things. 

So, I really hope that this study not only has the effect that you guys are intending it to have, but also forms the basis of future insights that we continue to learn, to continue to make the world a better place for people regardless of what sort of incontinence issues they're dealing with. So, thank you very much. 

Dr. Diane Newman: Well, we thank you for allowing us to present this research because your audience is wide and varied, and I know this will be of interest to them, so we really appreciate you having us. 

Bruce Kassover: Life Without Leaks has been brought to you by the National Association for Continence. Our music is Rainbows by Kevin McLeod. More information about NAFC is available online at nafc.org.