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Table 1 Context of services and care in study sites

From: Implementing pelvic floor muscle training for women with pelvic organ prolapse: a realist evaluation of different delivery models

Site Service context Service model adopted Skill mix trained
A Urban, POPPY site No change. Existing primary and secondary care provision of specialist physiotherapy. Referrals triaged. Specialist physiotherapists (existing team)
(2 x band 7, 5 x band 6 women’s health physiotherapists)
Care context • Service proudly described as gold-standard care – adequate numbers of highly trained staff, good working relationships and communication flow, team approach to practice, well resourced.
• Improvements seen to be needed in raising awareness among GPs to enable direct referrals, improving waiting times, referral pathways and follow-up care.
B Rural PROPEL PFMT training provided to a variety of clinicians over a large geographical area. Including clinicians with special interest, district nurses, continence nurses and physiotherapists. PROPEL women triaged by specialist physiotherapist prior to referral into the PROPEL service. Community and secondary care based. 2 x Musculoskeletal (MSK) physiotherapists band 6
1 x General physiotherapist band 6
2 x District nurses
1 x Lead nurse specialist in continence band 6
2 x Urogynaecology nurses
Care context • Incontinence service worked closely with physiotherapy, but seen as ‘pad provision’ service, needing to become more holistic and proactive in assessment and treatment
• Staff shortages prevalent – patients and staff needing to travel long distances
• High levels of motivation among staff, many with special interest in women’s health. Service had history of training MSK physiotherapists in PFMT delivery. Support from management was strong.
C Urban New provision of PFMT delivery developed for PROPEL based in secondary care. Consultant triaged and referred into PROPEL service provided by urogynacology nurses 3 x Urogynaecology nurses trained, 2 took part in PROPEL
Care context • Perceived to have lack of co-ordination between primary and secondary care services with regards to prolapse and incontinence
• Perceived need for service design and some level of enthusiasm about PROPEL among acute and community nurses, management and some consultants.
D Urban Community healthcare setting. Current PFMT service delivered by small number of specialist physiotherapists. 4 clinicians to deliver PROPEL service in a community healthcare setting 4 x MSK physiotherapists
(1 x band 5, 2 x band 6 and 1 x band 7)
Care context No phase 1 data available
E Urban Current PFMT service delivered by small number of specialist physiotherapists. 4 trained clinicians to deliver PROPEL service in a community healthcare setting 2 x Urogynaecology nurses
2 x Physiotherapists
(1 x band 5, 1 x band 6)
Care context No phase 1 data available