It’s About Patient Dignity

Helping incontinence patients manage their conditions.

More than 13 million Americans are affected by incontinence, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Most, if not all, suffer from embarrassment over their condition. Despite the large incidence of incontinence, the condition carries a stigma and embarrassment that makes it hard for providers to help those patients.

“Incontinence is a very personal and private health issue, and most of the time it’s very difficult to initiate any kind of in-depth discussion with the patient,” says Chuck Blackburn, co-owner and chairman of the board of directors of BLACKBURN’S, an HME provider that has been in operation for 72 years, and is one of the largest independent providers in western Pennsylvania. Besides being a registered pharmacist, Blackburn practiced as an Enterostomal Therapist for years, assisting patients with various kinds of incontinence issues. He says getting incontinence patients to open up is a tough nut to crack.

“They’re reluctant to even share information with their doctor,” he says, explaining that patients might come into an HME provider with a goal of trying to self-treat their condition without having any sort of dialog with staff. “So they’re confronting the provider with a deep interest in trial and error; a ‘Leave it up to me, I’ll figure it out’ kind of approach.”

And that’s if the patient bothers to come into the store. The provider often deals with a proxy.
“Many, many times you’re not dealing with the patient,” Blackburn explains. “You’re dealing with a close friend, or a spouse, or a relative, who’s been talked into acting as the intermediary to go after a product or help ... So you don’t get the kind of questions answered you need answered to determine what’s the best kind of product.”

Starting a Dialog

So the first priority in working with incontinence patients is getting them to come into the provider’s shop. Blackburn says that starts with creating a comfortable, private space.

“The first thing you need to do is have a private area — not just a consulting room like you do for a prescription pharmacy,” Blackburn says. “You have to have a completely enclosed, private area that also has a toilet and washbasin. We found this especially true if you are helping ostomy patients, obviously.”
That room and those facilities will help patients clearly demonstrate the problems they are having so that the provider can help them chose the right solution.

Have the Right Staff and Train Them

Of course, having a private area is only one part of ensuring a healthy, up-front patient dialog. The other part is having a mature, professional staff member on the other end of the discussion.

“It’s very difficult to share all this private information with a recently graduated high school student,” Blackburn says. “The person has to have some kind of training in the normal urinary track and bowel function, and what an abnormal one is.”
In terms of specific training, Blackburn says a good place to start is looking at what state HME associations, pharmaceutical societies, and other trade associations have to offer in the way of seminars addressing incontinence.

“It might be sufficient to have a registered nurse come in and sit down with the staff and go over some of the basic concepts of incontinence,” he says. “You have to have a little bit of vocabulary to communicate with the patient and give them ideas to discuss with their physician.”

Develop Referral Relationships

Bolstering that provider-physician relationship ensures incontinence patients get the best solution. When Blackburn first became involved in helping incontinence patients, he said he immediately discovered that physicians were grateful to have someone else to help those patients with a broad knowledge of options.

“It becomes a collaboration between what the physician can do from a medical and pharmacological point of view, and what the provider can do from a physical device point of view,” he says. “A lot of physicians are not always up on the latest products being offered.”

Know the Product Options

This gives providers a golden opportunity to add value to the relationship.“You have to develop a recognizable expertise in the knowledge of products and basic knowledge of the physiology, and be able to relate this to the patient, so that you can say, ‘This product is going to work,’” Blackburn says. That means not only knowing product capabilities, but limitations.

Through the years, there have not been incontinence options that providers could cite as being 100 percent effective and reliable, according to Blackburn. Most do a moderate job of meeting expectations. The key is to know all of them, how they relate to the condition, the patients, and the physiology and make the best match.

“The encouraging part is that there are so many devices out there that if you know the range of products are available you can narrow it down to the range of products that you think are going to be most effective,” Blackburn says.

This article originally appeared in the February 2009 issue of HME Business.

About the Author

David Kopf is the Publisher and Executive Editor of HME Business and DME Pharmacy magazines. Follow him on LinkedIn at and on Twitter at @postacutenews.

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