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The future of pelvic floor services in the UK
A J Hainsworth1, A M P Schizas2, S Brown3
1Pelvic Floor Unit, Colorectal Surgery, St Thomas' Hospital, London, UK. allyhainsworth@googlemail.com.
Insights
UK pelvic floor services vary, with many centers lacking dedicated clinics or multidisciplinary meetings. An integrated approach is needed to improve pelvic floor disorder care across all service levels.
Area of Science:
- Colorectal surgery
- Pelvic floor disorders
- Healthcare service provision
Background:
- Pelvic floor disorders affect a significant patient population, necessitating specialized care.
- Current UK pelvic floor services require evaluation to identify gaps and inform future strategies.
Purpose of the Study:
- To assess the current provision of pelvic floor services across the UK.
- To identify variations in service delivery among local, regional, and tertiary centers.
- To propose future strategies for integrated pelvic floor care.
Main Methods:
- A 2014 questionnaire survey was distributed to 175 UK colorectal units.
- Data collected included center type, clinic frequency, multidisciplinary meeting (MDM) attendance, and workload.
- The survey targeted units recognized by the Association of Coloproctology of Great Britain and Ireland.
Main Results:
- A 38% response rate was achieved, with a bias towards centers affiliated with the Pelvic Floor Society.
- Tertiary centers (39%) were more likely to offer pelvic floor clinics (80%) and MDMs (84%) than regional centers (56% and 75%, respectively).
- Advanced diagnostic tools like anal ultrasonography and anorectal physiology were more prevalent in tertiary centers (96%) compared to non-tertiary units (50%).
Conclusions:
- UK pelvic floor service provision is fragmented across local, regional, and tertiary levels.
- Inconsistent availability of dedicated clinics and MDMs was observed, even in higher-tier centers.
- An integrated, multidisciplinary approach is crucial for optimizing pelvic floor disorder management.
Aim:
The study aimed to determine the current state of UK pelvic floor services and to discuss future strategies.
Method:
A questionnaire developed by the Pelvic Floor Society was sent in 2014 to the 175 colorectal units recognized by the Association of Coloproctology of Great Britain and Ireland. Questions included type of centre, frequency of pelvic floor clinics/interdisciplinary joint pelvic floor clinics/multidisciplinary meetings (MDMs) and workload.
Results:
Sixty-seven (38%) centres replied including 75% of units with a consultant who was as member of the Pelvic Floor Society. Of the 67 centres 39% were tertiary centres for pelvic floor surgery (tertiary), 48% performed some pelvic floor surgery (regional) and 13% did not perform any (local). Ninety-six per cent of tertiary referral centres served a population over 500 000. The mean number of whole time equivalent consultants in tertiary centres was 1.03 and 0.77 in regional centres. Eighty per cent of tertiary centres and 56% of regional centres ran pelvic floor clinics. Eighty-four per cent of tertiary referral and 75% of regional units held or attended an MDM. Anal ultrasonography, anorectal physiology and proctography were performed in 96% of tertiary centres compared with 50% of non-tertiary units.
Conclusion:
The provision of pelvic floor services includes local, regional and tertiary centres. The overall response rate was low (38%) and biased to centres with a consultant who was a member of the Pelvic Floor Society. Not all regional or tertiary centres held an MDM or a pelvic floor clinic. Given the nature of pelvic floor pathology an integrated service should be aimed at linking different centres and specialities.
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