A service evaluation to determine where and who delivers pessary care in the UK

Dwyer, Lucy; Stewart, Ellie; Rajai, Azita

doi:10.1007/s00192-020-04532-w

Cited by 6 publications

(14 citation statements)

References 19 publications

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“…This calculation is based on 90 min of a band six nurse or physiotherapist’s time to provide initial self-management teaching and subsequent telephone follow-up. It is important to note, the significant cost savings calculated are based on clinician-led pessary care being provided by doctors, whereas at most organisations in the UK it is provided by a combination of doctors and nurses 58. This may affect projected cost savings.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…It is important to note, the significant cost savings calculated are based on clinician-led pessary care being provided by doctors, whereas at most organisations in the UK it is provided by a combination of doctors and nurses. 58 This may affect projected cost savings. Open access DISCUSSION Despite a number of factors being associated with lihood to self-manage, [16][17][18][19][20][21][22][23][24] a causative relationship has not been established with any.…”

Section: Cost Benefitmentioning

confidence: 99%

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What is known from the existing literature about self-management of pessaries for pelvic organ prolapse? A scoping review

2022

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ObjectivesPelvic organ prolapse can be managed with a pessary. However, regular follow-up may deter women due to the inconvenience of frequent appointments, as well as preventing autonomous decision making. Pessary self-management may be a solution to these issues. However, there remains a number of uncertainties regarding pessary self-management. This scoping review aims to map available evidence about pessary self-management to identify knowledge gaps providing the basis for future research.DesignScoping review as detailed in the review protocol.Data sourcesA search of MEDLINE, CINAHL, EMBASE and PsycINFO databases and a handsearch were undertaken during May 2021 to identify relevant articles using the search terms ‘pessary’ and ‘self-management’ or ‘self-care’.Data extraction and synthesisData relevant to pessary self-management was extracted and the Mixed Methods Appraisal Tool used to assess empirical rigour. Thematic analysis was performed to evaluate the results.ResultsThe database search identified 82 publications. After duplicates and articles not meeting the inclusion and exclusion criteria were removed, there were 23 eligible articles. A hand search revealed a further 19 articles, resulting in a total of 42 publications.Findings relevant to pessary self-management were extracted and analysed for the emergence of themes. Recurrent themes in the literature were; the characteristics of self-managing women; pessary care; factors associated with decision making about self-management; teaching self-management and cost benefit.ConclusionsPessary self-management may offer benefits to some women without increased risk. Some women do not feel willing or able to self-manage their pessary. However, increased support may help women overcome this. Further in-depth exploration of factors which affect women’s willingness to self-manage their pessary is indicated to ensure better understanding and support as available for other conditions.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Cost Benefitmentioning

confidence: 99%

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What is known from the existing literature about self-management of pessaries for pelvic organ prolapse? A scoping review

2022

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“…In contrast to pessary regulation set by the TGA, standards of patient care and responsibility of clinical practice lies with the clinician. This is assisted by relevant professional codes of conduct, guidelines and policies 29,[44][45][46][47][48] . A range of healthcare practitioners provide pessary care, including doctors, nurses and physiotherapists 16,[45][46] .…”

Section: Standards In Training Of Pessary Practitionersmentioning

confidence: 99%

Pessary management for pelvic organ prolapse: a review of clinical practice and Australian medical device regulations

Franks,

Krause

2023

ANZCJ

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Pelvic organ prolapse affects up to 50% of women throughout life. Management can be conservative or surgical. Pessaries have become an integral component to management of pelvic organ prolapse, providing symptom improvement and enhancing quality of life. After careful clinical assessment, women choosing pessary management are offered either self-care or clinician-based pessary care. Pessary care can be offered by a range of clinicians, including doctors, nurses and physiotherapists. In this article we review the literature on the historical use of pessaries and how they have changed to be the device manufactured today. We then outline the Australian regulation of vaginal pessaries as per the Therapeutic Goods Administration (TGA). We discuss device classification in relation to clinical practice and guidelines.The TGA classifies pessary devices as either Class 1: device which is intended for transient use, Class 2A: to be used continuously for at least 60 minutes but not more than 30 days, and Class 2B: continuous use for more than 30 days. The majority of pessaries available in Australia are classified as 2A devices.

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“…Many different healthcare professional groups provide pessary care in the UK including nurses, medical doctors, physiotherapists, midwifes and clinical support workers [45]. Furthermore, there is extensive variation in training standards for pessary practitioners at different organisations in the UK [45]. This meant a pragmatic approach regarding who delivered the intervention was necessary.…”

Section: Intervention Delivery and Trainingmentioning

confidence: 99%

Theoretical and practical development of the TOPSY self-management intervention for women who use a vaginal pessary for pelvic organ prolapse

Dwyer

Bugge²,

Hagen³

et al. 2022

Trials

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Background Pelvic organ prolapse (POP) is a common condition in women, where the downward descent of pelvic organs into the vagina causes symptoms which impacts quality of life. Vaginal pessaries offer an effective alternative to surgery for the management of POP. However, the need for regular follow-up can be burdensome for women and requires significant healthcare resources. The TOPSY study is a randomised controlled trial which aims to determine the clinical and cost-effectiveness of self-management of vaginal pessaries. This paper describes the theoretical and practical development of the self-management intervention. Methods The intervention was developed using the MRC complex intervention framework, normalisation process theory (NPT) and self-management theory. The intervention aims to boost perceived self-efficacy in accordance with Bandura’s social cognitive theory and is guided by the tasks and skills Lorig and Hollman describe as necessary to self-manage a health condition. Results The TOPSY intervention was designed to support women to undertake the medical management, role management and emotional management of their pessary. The six self-management skills described by Lorig and Hollman: problem-solving, decision-making, resource utilisation, formation of a patient-provider partnership role, action planning and self-tailoring, are discussed in detail, including how women were supported to achieve each task within the context of pessary self-management. The TOPSY intervention includes a self-management support session with a pessary practitioner trained in intervention delivery, a follow-up phone call 2 weeks later and ongoing telephone or face-to-face support as required by the woman initiated by contacting a member of the research team. Conclusions The TOPSY study intervention was developed utilising the findings from a prior service development project, intervention development and self-efficacy theory, relevant literature, clinician experience and feedback from pessary using women and members of the public. In 2022, the findings of the TOPSY study will provide further evidence to inform this important aspect of pessary management. Trial registration ISRCTN Registry ISRCTN62510577. Registered on June 10, 2017

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A service evaluation to determine where and who delivers pessary care in the UK

Cited by 6 publications

References 19 publications

What is known from the existing literature about self-management of pessaries for pelvic organ prolapse? A scoping review

What is known from the existing literature about self-management of pessaries for pelvic organ prolapse? A scoping review

Pessary management for pelvic organ prolapse: a review of clinical practice and Australian medical device regulations

Theoretical and practical development of the TOPSY self-management intervention for women who use a vaginal pessary for pelvic organ prolapse

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