PCOS Poster - Van Liere Research Day

1. PCOS estimated prevalence of 5-10% 1,2 Most common endocrine disorder in women 1,2 Lifestyle intervention is the first-line treatment for women with PCOS 3 The literature documenting the efficacy of multidisciplinary PCOS clinic have demonstrated: I ncreased weight loss 4,5 H igh patient satisfaction rates 5 H igh retention rates 4,5 The literature documenting the current utilization of dietitians in PCOS suggests: Only 26% of overweight PCOS patients received a referral for a dietitian 6 Only 15 % PCOS patients saw a dietitian and 3 % had seen an RD for more than twice 7 To investigate current trends in multidisciplinary treatment of PCOS across different providers To describe potential implications of future multidisciplinary PCOS clinics To explore the role, importance and challenges for RDs in multidisciplinary PCOS treatment Role of the Dietitian in Multidisciplinary Treatment of Polycystic Ovary Syndrome Wendy M. Thompson 1 ; Pamela J. Murray, MD, MHP 2 ; Melanie J . Clemmer , PhD 3 ; Melissa D. Olfert DrPH , MS, RD, LD 1,4 West Virginia University: 1 Davis College of Agriculture, Natural Resources and Design - Department of Human Nutrition and Foods; 2 School of Medicine – Department of Pediatrics, Adolescent Medicine; 3 School of Medicine – Department of OB/GYN, 4 School of Public Health OBJECTIVES FOCUS GROUP DEMOGRAPHICS BACKGROUND IMPLICATIONS OF FUTURE MULTIDISCIPLINARY CLINICS CONCLUSIONS METHODS This was a two tier study with survey followed by a series of focus groups to gather information from health care providers who treat PCOS. PCOS is a complex condition that requires the expertise of multiple provider types to treat the syndrome in its entirety. Most providers agree that a multidisciplinary clinic would provide greater convenience, access to care, and ultimately lead to a better prognosis for patients with PCOS. The perceived barriers that prevent clinics from becoming multidisciplinary would need to be well defined, but providers indicate enthusiasm for the opportunity to implement a multidisciplinary approach. Lifestyle interventions are heavily overlooked in the treatment of PCOS and there are many challenges to incorporating dietitians but with improvements in education and insurance they can play an integral role in PCOS. Funding: WVU Agriculture Experimental Station Hatch Project (PI-Olfert) Scan this QR Code to view electronic copy of poster! Do you have a smart phone ? Go to the App Store Search “QR Code Reader” Download , Open, & Scan ! Needs Improvement: More multidisciplinary involvement (34%) Expanding nutrition and exercise programs (30%) Eliminating access barriers (10%) Patient wait- time, c ost, insurance Strengths: Treatment/management of symptoms (21%) Lifestyle changes (21%) Patient education/counseling (20%) Multidisciplinary collaboration (17% ) EXISTING CLINIC OUTCOMES About the Clinics About the Patients SURVEY DEMOGRAPHICS Demographics # Selected % Selected Sex Male 44 22% Female 159 78% Location USA 117 64% Outside of the US 67 36% Population Setting Urban 98 70% Suburban 33 23% Rural 9 6% Other 1 1% Multidisciplinary Setting Yes 79 59% No 56 41% Comprehensive Approach Yes 111 79% No 29 21% Breakdown of specialties involved with the responders in their PCOS facilities: The survey ( Qualtrics , Provo, UT ) consisted of 30 questions , which included multiple-choice, multiple-response, and open-ended questions targeting information on their current treatment facility and approach, and perspectives about multidisciplinary clinics. The series of focus groups were conduced via teleconference and consisted of seven open-ended questions , which targeted information on the current utilization of nutrition interventions for PCOS and the challenges for involving dietitians. Data was analyzed using a thematic analysis. Focus Group Questions Specialty # Involved % Involved Dietitian/Nutritionist 94 71% Physician 89 67% Nurse 63 48% Fertility Specialist 46 35% Mid-Level Providers (NP, PA) 37 28% Social Worker 37 28% Psychologist 34 26% N = 132 POTENTIAL BARRIERS POTENTIAL ADVANTAGES FOCUS GROUP RESULTS CA NV GA MA PA Communication Differences: Solo Providers: Limited opportunity for face-to-face Only progress notes and occasional emails Not ideal, but still effective Multidisciplinary Providers: More verbal communication and integration Varies by setting Desires more communication What Warrants Dietary Intervention? Always important to discuss and provide nutrition counseling Equally important regardless of BMI Immediately upon on diagnosis patients should meet with RD First line treatment Accessibility: NOT VERY ACCESSIBLE! Overweight and obese More symptomatic More obvious referrals Lean PCOS Overlooked Top Challenges for Dietitians and PCOS The Importance of Dietitians for PCOS Treatment: Adequate lifestyle interventions Physicians should not be fully responsible: Little to no training “They can only be the experts on so many things” Takes time “More than just handing the patient a 1,200 kcal diet plan” *Average length of visit = 18.7 minutes (CDC, 2007 ) “The better the clinician understands PCOS, the better they are able to treat it.” “Often times nutrition counseling is treated like dermatology and it needs to be treated more like psychology.” N = 76 N = 82 Percentage of Participant Ideal Involvement of Providers in Future PCOS Clinics N = 184 Participants all had extensive experience (6-25 years) treating PCOS patients and included: Registered Dietitians (4), Physicians (3), Health Psychologist (1), and Nutritionist (1) Wendy Thompson Graduate Dietitian Intern MS Candidate in Human Nutrition