Improving Primary Care Providers' Knowledge and Utilization of Pessaries in Women with Pelvic Organ Prolapse

Background:Primary care providers receive minimal to no training on vaginal pessaries as a treatment option for pelvic organ prolapse (POP). This lack of knowledge leads to women suffering from pelvic organ prolapse with minimal treatment options available. Patients that are not candidates for surgical repair of POP may have a decreased quality of life from prolapse. Methods:This quality improvement project contacted primary care clinics in Utah to assess willingness to learn more about vaginal pessaries. Two clinics and 15 providers agreed to participate. An evidence-based education module to improve primary care provider knowledge and utilization of pessaries for women with POP was developed. A pre- and post-test questionnaire were distributed before and after the educational module was presented to measure current provider practices surrounding POP and vaginal pessaries. To evaluate the effectiveness of the intervention, willing providers were contacted one-month following the presentation to ask about changes in practice surrounding POP and pessaries. Results: Prior to the educational module, 26.7 percent (n=4) of providers were unable to correctly identify the first-line recommended treatment for POP. More than half, or 53.3 percent (n=8), of primary care providers reported they had never diagnosed a patient with pelvic organ prolapse. Having completed the educational module, the average comfort level with diagnosing POP increased by 66.4 percent. Providers also reported that familiarity with vaginal pessaries increased from somewhat familiar (3 2.00) to extremely familiar (5 0.00) following the educational module. A Wilcoxon Signed Ranks Test indicated that post-test likelihood to recommend a vaginal pessary as treatment for POP was statistically significantly higher than pre-test likelihood to recommend a vaginal pessary as treatment for POP (Z = 21.0, p < 0.027).Conclusions: Results of this study showed provider knowledge on pelvic organ prolapse and vaginal pessaries can be improved. Improving provider knowledge may have a direct effect on the quality of life for women suffering from POP who are not candidates for surgery, cannot afford surgery, or are otherwise uninterested in surgery