Enabling self-management for patients using vaginal pessaries Cambridge University Hospitals NHS Foundation Trust

The Cambridge University Hospitals NHS Foundation Trust team tested a self-management pathway for women using vaginal pessaries for pelvic organ prolapse. Although well-established in North America, the pathway was new to the UK. The team wanted to establish whether the self-management approach involves far fewer outpatient clinic appointments, which many women find stressful and uncomfortable, and also helps to free up consultant time. 

The project team worked with a focus group of pessary users to design the service and produce a patient information leaflet. The team introduced the new approach to small groups of patients, using plan, do, study, act (PDSA) cycles to make sure that the pathway was safe and effective, before rolling it out more widely.

Who was involved

The project was led by a consultant gynaecologist. Other team members included a specialist nurse, the deputy operations manager, the finance lead and a data analyst. Patients were supported by a women's health physiotherapist based at Addenbrooke's Hospital.

Outcomes

• Improved patient experience for women following self-management - 90% said their pessary changes were comfortable, compared to 53% of the control group who continued seeing a doctor for pessary changes.
• 100% of women following self-management for longer than three months planned to continue pessary use in the long term, compared to 71% of the control group. This suggests that self-management can reduce the likelihood of surgical intervention.
• Around 100 outpatient clinic appointments freed up.
• Moving 50 patients to self management saves the hospital trust £5,500 and commissioners £8,400.

Challenges

The patient referral rate was initially slow, so the team extended the referral sources to local GP surgeries and other health care professions. 

Supporting dissemination

This project has been given further support through a Spreading Improvement award to help disseminate learning and maximise the impact of the approach across the health service at a local, regional or national level.

Funding will be used to take pessary self-management to a wider audience by developing a network of health care providers across the East of England who are interested in offering the approach to their patients. A train the trainer programme will also be developed and rolled out across the network to enable practitioners to train their own patients in self management. Learning from the project will be shared with commissioners across the East of England with the aim of encouraging wider adoption.