Establishing a continence nurse-led pessary clinic as a new model of care for women in rural Victoria

Use of vaginal pessaries to treat vaginal prolapse and incontinence is experiencing renewed interest in Australia. The premise of this study was that a nurse-led pessary clinic would facilitate this treatment option for rural women who would otherwise have to travel long distances to metropolitan centres to access this therapy. The aim was to establish a nurse-led pessary clinic for rural women and examine patient uptake and health outcomes. Competency for assessment, fitting and ongoing management of clients using pessaries was achieved through training and expert support from experienced continence nurse advisors and gynaecologists. Women were referred to the pessary clinic, either directly by their general practitioner, or by the continence nurse advisor from the continence clinic once a continence assessment and management plan was completed, and after discussion with their doctor. Thirty-nine women were referred to the pessary clinic over the first 31 months. Three women who had a pessary already fitted were referred for management and were ineligible for this study. Seven women declined a pessary and seven were not suitable for a pessary. Twenty-two women participated in this study and of those 17 were successfully fitted with a pessary. Only four participants continued with the pessary after three months. All women completed a pre-post questionnaire to assess bladder and vaginal symptoms. The study demonstrates the practicalities of developing a new model of care in a rural setting. Expert support is a key factor in providing this treatment option.