•  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

•  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

0 10 20 30 40 50 60 70

Hospital or Clinic

Private Office

Research Facility

Other

66%

45%

8% 4%

% o

f Res

pond

ers

Responders’ Treatment Setting

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

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)

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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

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:

Survey Participants

N=261

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

LinkedIn Groups

Direct emails to providers

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

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%)

Comprehensive and integrated care (32%)

Convenience/efficiency (30%)

Better results & long-term outcomes (18%)

Better communication between providers (15%)

Increased access to more disciplines (10%)

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 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

Insurance

Lack of knowledge

Lack of physician referrals

Patient follow-though

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

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

Perce

ntage

of P

artic

ipant

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