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Abstract

Introduction: Incontinence and/or pelvic organ prolapse symptoms are prevalent in women in Australia and the estimated healthcare cost is considerable. Internationally accepted best practice evidence supports a trial of conservative Physiotherapy treatment with a Physiotherapist trained in the management of pelvic floor dysfunction before surgical options should be considered. Existing referral pathways in the tertiary healthcare system to access conservative Physiotherapy treatment require direct referral from Gynaecology staff. Objective: To identify the pathway to conservative pelvic floor physiotherapy for women referred to a tertiary hospital in Australia with incontinence and/or pelvic organ prolapse symptoms following existing referral pathways. Results: Attendance data for the period January to June 2015 identified 63 women as being primarily referred for incontinence and/or pelvic organ prolapse by their local healthcare provider. Half of these 63 women (n = 31) were referred on to Physiotherapy for conservative management; the other half were not. The time between local healthcare provider referral to specialist Gynaecology appointment ranged from 49 days to 351 days (average 169.6 days). Of the 31 women referred to Physiotherapy, the majority (n = 22, 70.9%) were referred on the day of their initial Gynaecology consultation, the 9 remaining women waited between 2 to 126 days for Physiotherapy referral. The shortest pathway from local healthcare provider referral to Physiotherapy consultation was 64 days; the longest pathway was 402 days. Of the 31 women who were not referred to Physiotherapy, 18 (58%) proceeded directly to surgery. Conclusion: This audit demonstrates that existing referral pathways for women referred with incontinence and/or pelvic organ prolapse create lengthy delays between local healthcare provider referral and access to Physiotherapy services. Only half of those women who would be appropriate for a trial of conservative therapy are being referred to Physiotherapy which is in direct contrast to the widely accepted best practice guidelines for the management of pelvic floor dysfunction mandating conservative therapy as a first line approach for these conditions. The opportunity to implement an advanced scope model of care that promotes more timely access and earlier commencement of conservative Physiotherapy for these women would significantly improve the clinical care pathway for this cohort of patients in the tertiary healthcare setting.

Author Bio(s)

Tara Beaumont, B. App Sc (Physio), PG Cert (Cont PF Rehab), completed her Bachelor of Science (Physiotherapy) in 2001 at the University of South Australia. She has been employed at the Women’s and Children’s Hospital since 2002. After completing her Post Graduate Certificate (Continence and Pelvic Floor Rehabilitation) at the University of Melbourne in 2006, she was appointed to the Head of Unit, Women’s Health Physiotherapy position in 2007. She is currently job sharing this role with Kate Goode after a period of maternity leave.

Kate Goode, B. Physio, APAM, completed her Bachelor of Physiotherapy in 2010 at the University of South Australia. She has been employed at the Women’s and Children’s Hospital since 2011. She completed her Post Graduate Certificate (Pelvic Floor Rehabilitation) in 2014 and Master of Physiotherapy in 2015 at the University of Melbourne. She has been job sharing the role of Head of Unit, Women’s Health Physiotherapy since 2013.

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