2.5

12.5

22.5

32.5

42.5

52.5

62.5

Highly Involved

Involved Neutral Occasionally Involved

Never Involved

Dietitian

Endocrinologist

Gynecologist

Fertility Specialist

Exercise Physiologist

Health Psychologist

•  PCOS estimated prevalence of 5-10%1,2

•  Most common endocrine disorder in women1,2 •  Lifestyle intervention is the first-line treatment for women with PCOS3 •  The literature documenting the efficacy of multidisciplinary PCOS clinic have

demonstrated: •  Increased weight loss4,5 •  High patient satisfaction rates5 •  High retention rates4,5

•  The literature documenting the current utilization of dietitians in PCOS suggests: •  Only 26% of overweight PCOS patients received a referral for a dietitian6

•  Only 15% PCOS patients saw a dietitian and 3% had seen an RD for more than twice7

1.  To investigate current trends in multidisciplinary treatment of PCOS across different providers

2.  To describe potential implications of future multidisciplinary PCOS clinics 3.  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. Thompson1; Pamela J. Murray, MD, MHP2; Melanie J. Clemmer, PhD3; Melissa D. Olfert DrPH, MS, RD1,4

West Virginia University: 1Davis College of Agriculture, Natural Resources and Design – Department of Human Nutrition and Foods; 2School of Medicine – Department of Pediatrics, Adolescent Medicine; 3School of Medicine – Department of OB/GYN, 4School of Public Health

OBJECTIVES FOCUS GROUP DEMOGRAPHICS

BACKGROUND

IMPLICATIONS OF FUTURE MULTIDISCIPLINARY CLINICS

CONCLUSIONS

METHODS This was a two-tier formative 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 agreed that multidisciplinary clinics would ultimately lead to a better prognosis for PCOS patients. A greater emphasis needs to be placed on educating the medical community, including dietitians and physicians, on the importance of specialized nutrition counseling and lobbying for insurance reimbursement. Having access to dietitians educated on PCOS is likely the best way to ensure that PCOS patients have access to lifestyle interventions, which is considered to be the first-line treatment for PCOS. Funding: WVU Agriculture Experimental Station Hatch Project (PI-Olfert)

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Needs Improvement: •  More multidisciplinary involvement (34%) •  Expanding nutrition and exercise programs

(30%) •  Eliminating access barriers (10%)

•  Patient wait-time, cost, 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

Population Setting

Urban 98 70%

Suburban 33 23%

Rural 9 6%

Multidisciplinary Setting

Yes 79 59%

No 56 41%

Treatment Setting

Hospital or Clinic 135 66%

Private Office 92 45%

Research Facility 17 8%

Other 9 4%

Breakdown of specialties involved with the responders in their PCOS facilities:

Survey Participants

N=261

List Serves: • SAHM • NASPAG • SART-ASRM • EmbryoMail

LinkedIn Groups

Direct emails to providers

Survey Design: •  Anonymous, Internet-based •  30 questions

•  Demographics •  Current treatment facility •  Future Implications

Focus Group Design: •  Teleconference •  7 open-ended questions •  Analyzed using thematic analysis

Focus Group

Participants N=9

US Survey Participants

(n=22)

Additional PCOS

Experts (n=12)

Referrals (n=4)

Participants’ Treatment

Facility

•  “Describe any nutritional interventions that you provide to your patients” •  “How are dietary interventions and patient care communicated between

providers?”

Utilization of Nutritional

Interventions

•  When is dietary intervention warranted for a patient with PCOS? •  How accessible are nutritional interventions for the majority of PCOS patients?

Challenges and Changes

•  “What are some of the challenges for getting dietitians more involved with PCOS?”

•  “Do you feel like providers know and understand the value of nutritional interventions for PCOS patients?”

•  In your career, have you seen any shift in the awareness or interest of PCOS?

Focus Group Questions

59%

20%

5% 3%

3% 3% 7%

Provider Type

Physicians

Dietitians

Fertility Specialist

Researchers

Midlevel Providers

Educator/Counselors

Other N = 210

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

Money and resources (30%)

Insurance/reimbursement (26%)

Difference of opinions (16%)

Time (12%)

Increased access

to disciplines (10%)

Better communication between providers (15%)

Better results & long-term outcomes (18%)

Convenience/efficiency (30%)

Comprehensive and integrated care (32%)

POTENTIAL BARRIERS POTENTIAL ADVANTAGES

FOCUS GROUP RESULTS

0

1

2

3

4

West Mid-West South Northeast

# of

Par

ticip

ants

USA Regions Represented

IN, MN WI, MO

CA NV

GA

MA PA

67%

33%

Multidisciplinary Status

Yes

No

Communication Differences: •  Solo Providers:

•  Limited opportunity for face-to-face •  Only progress notes and 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

Insurance

Lack of PCOS knowledge

Lack of physician referrals

Patient follow-though

Top Challenges for Dietitians and PCOS

Accessibility: •  NOT VERY ACCESSIBLE!

•  Overweight and obese •  More symptomatic •  More obvious referrals

•  Lean PCOS •  Overlooked

The Importance of Dietitians for PCOS Treatment: •  Adequate lifestyle interventions •  Physicians should not be fully

responsible: •  Little to no training •  Takes time

•  “More than just handing the patient a 1,200 kcal diet plan”

N = 76 N = 82

Perce

ntage

of P

artic

ipants

Ideal Involvement of Providers in Future PCOS Clinics

Participants all had extensive experience (7-25 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

N = 9