Hypothesis / aims of study
Pelvic floor disorders are a common, but complex dysfunction which can be managed effectively at a primary care level using conservative treatment. First contact models of care have been shown to be effective in providing diagnostic evaluation and management of many patient conditions, improved access to care and reduction in specialist outpatient waiting lists. Global barriers to implement such models of care include cost of care and limited resources to providing integrated services at a primary care level (1). It requires a coordinated and multidisciplinary care structure which might be hard to implement due to challenges such as limited resources in middle to low income countries such as South Africa. This leads to patients not receiving optimal care and recovery post-interventions.
This study therefore aimed to explore the barriers and facilitators associated with an integrated approach to deliver pelvic and women`s health services within a South African context.
Study design, materials and methods
In-depth interviews (n=16) and a focus group (n=8) were used to explore the opinions of clinicians, researchers, managers, patients and educationalists on the barriers and facilitators associated with an integrated approach to provide optimal pelvic and women`s health services within a diverse healthcare system in South Africa. Content thematic analysis was used to analyze and interpret the data. The data was coded to establish themes and sub-themes. Consequently it was indexed, tabulated and mapped to make links between the themes. The themes were grouped together into predetermined and emerging categories based on similarities in the context of the comments made by the participants.
Results
Interviewees included five included physiotherapists, two urogynaecologists, two patients, three managers, one psychologist, dietitian and urologist, represented clinicians, researchers, postgraduate students, and educationalists. The focus group included health care practitioners within the private and public health care sector, two managers, two educationalists and two researchers in the field or urogynaecology. The mean age and the mean years of experience of the participants were 45.73 ± 14.95 years and 17.31 ± 12.73 years respectively. The major challenges seemed to be a lack of initiative to implement interprofessional collaborative clinics, a fear of compromising quality of patient care, rules and legislation regarding logistical aspects, and limited resources. The following were highlighted as facilitators and benefits of increasing implementation of interprofessional clinics: optimise use of existing resources; improved opportunities for clinical and skills training; outcomes can inform policy; it provides a platform for comprehensive and inclusive research strategies.
Interpretation of results
It seems as if the benefits may outweigh the barriers and that an integrated interprofessional model of patient care can lead to improved educational, research and clinical strategies to improve pelvic and women’s health services within a South African context. There is evidence that with strategic implementation a pelvic health clinic led by advanced health care practitioners can be an effective model of care for management of urinary incontinence and pelvic organ prolapse, regardless of group or individual initial contact. It is successful in providing good clinical and service outcomes that are well accepted by patients and staff.