PCOS Poster - Van Liere Research Day


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PCOS Poster - Van Liere Research Day

  1. 1. 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, RD, LD1,4 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 Wendy Thompson Graduate Dietitian Intern MS Candidate in Human Nutrition About the Patients About the Clinics SURVEY DEMOGRAPHICS BACKGROUND Demographics # Selected 3% Sex Male 44 22% 3% Female 159 78% 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 Direct emails to providers US Survey Participants (n=22) 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. Referrals (n=4) Focus Group Participants N=9 Survey Participants N=261 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 Participants’ Treatment Facility 117 Multidisciplinary Status Outside of the US 67 36% Midlevel Providers 20% Educator/Counselors Population Setting 98 70% Suburban 33 23% Rural 9 6% Other 1 1% Yes 33% Other Urban Multidisciplinary Setting Yes 79 59% No 56 41% Comprehensive Approach Yes 111 79% No 29 No Responders’ Treatment Setting 21% 70 60 50 40 30 20 10 0 67% • When is dietary intervention warranted for a patient with PCOS? • How accessible are nutritional interventions for the majority of PCOS patients? MA PA 2 GA 1 West N = 184 Mid-West South Northeast 45% FOCUS GROUP RESULTS 8% 4% Top Challenges for Dietitians and PCOS Hospital or Clinic Private Office Research Facility Other Insurance Needs Improvement: • More multidisciplinary involvement (34%) • Expanding nutrition and exercise programs (30%) • Eliminating access barriers (10%) • Patient wait-time, cost, insurance Lack of knowledge Breakdown of specialties involved with the responders in their PCOS facilities: Specialty # Involved % Involved Strengths: • Treatment/management of symptoms (21%) • Lifestyle changes (21%) • Patient education/counseling (20%) • Multidisciplinary collaboration (17%) 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 IMPLICATIONS OF FUTURE MULTIDISCIPLINARY CLINICS Ideal Involvement of Providers in Future PCOS Clinics 62.5 Dietitian 52.5 42.5 Gynecologist 32.5 22.5 Lack of physician referrals 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 Endocrinologist Fertility Specialist Exercise Physiologist Involved POTENTIAL BARRIERS Insurance/reimbursement (26%) Difference of opinions (16%) N = 76 Time (12%) Neutral Patient follow-though 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.” CONCLUSIONS 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. Health Psychologist Money and resources (30%) • “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? CA NV 3 0 66% 12.5 • “Describe any nutritional interventions that you provide to your patients” • “How are dietary interventions and patient care communicated between providers?” IN, MN WI, MO 4 Researchers 64% Highly Involved Challenges and Changes USA Regions Represented Dietitians 2.5 Utilization of Nutritional Interventions Physicians Fertility Specialist Percentage of Participant Additional PCOS Experts (n=12) • SAHM • NASPAG • SART-ASRM • EmbryoMail 59% EXISTING CLINIC OUTCOMES 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. List Serves: 3% Location METHODS LinkedIn Groups Participants all had extensive experience (6-25 years) treating PCOS patients and included: Registered Dietitians (4), Physicians (3), Health Psychologist (1), and Nutritionist (1) N = 210 7% 0% 5% USA • • • • Provider Type % Selected % of Responders • 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 FOCUS GROUP DEMOGRAPHICS # of Participants OBJECTIVES Occasionally Never Involved Involved POTENTIAL ADVANTAGES Comprehensiv e and integrated care (32%) Convenience/efficie ncy (30%) 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. Better results & long-term outcomes (18%) Funding: WVU Agriculture Experimental Station Hatch Project (PI-Olfert) Scan this QR Code to view electronic copy of poster! Better communication between providers (15%) Increased access to more disciplines (10%) N = 82 Do you have a smart phone? Go to the App Store Search “QR Code Reader” Download, Open, & Scan!