Assessing Access to Pessary Care: A Survey Study

Objectives: To compare the proportion of rural versus urban providers who fit pessaries within a health system that includes large rural populations. To survey primary care and OB/GYN physicians and advanced practice providers on characteristics that influence the provision of pessary care and inform potential ways to expand conservative management of pelvic organ prolapse.

Methods: Prevalence was assessed using an electronic medical record query of family, internal medicine, and OB/GYN specialties’ use of the pessary fitting billing code over a 24-month period. Rurality was defined by the Rural Urban Commuting Area (RUCA) Code assigned to the practice location. A 23-question survey was distributed using an electronic platform (Qualtrics, Provo, UT). The anonymous survey included questions on current pessary fitting practices, prior training, current barriers to pessary care, and desire for future training asked as categorical variables. Free form responses were also requested. Snowball sampling was permitted, and links were not unique to participants, therefore response rate was unable to be calculated. Fisher’s exact tests were utilized to assess between-group differences across categorical variables.

Results: The data query identified 426 providers. Forty-seven (11%) providers fit pessaries; 6 Urogynecologists (100%), 39 OB/GYNs (41%), and 2 Family Medicine Providers (1%) fit pessaries. Pessary fitting services did not differ significantly between rural and urban providers (13% vs 8%, p-value 0.09). The survey yielded 92 complete responses; 45 from women’s health providers and 47 from primary care. Among survey participants, 28 (30%) providers currently fit pessaries. Providers who currently fit and/or manage pessaries are significantly more likely to have gynecology specialty training and to have experience fitting pessaries during training (p-value < 0.0001). Provider practice area, years of experience, and credentials were not associated with pessary care (Table 1). Rural small-town practices were more likely to have primary care clinicians than GYN specialists (p-value < 0.0001), but credentials, experience, training in pessary care, prolapse screening or pessary care did not differ by location (Table 2). Providers who desire to provide pessary care were more likely to have a panel with a higher proportion of rural patients (73% vs 45% caring for >75% rural patients, p-value: 0.04), but did not differ across specialty (69% vs 74% primary care providers; p-value: 0.78). Formal training was desired by 100% of providers who currently do not fit pessaries but would like to.

Conclusions: Specialists in gynecology are more likely to provide pessary care than primary care providers. In our health system a high percentage of providers who fit pessaries work in urban areas, whereas those who wish to expand into pessary care have a higher proportion of rural patients. Formal training focusing on providers with rural patient panels may help improve access to pessary care for rural patients.