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)
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Better communication between providers
(15%)
Increased access to more disciplines (10%)
N = 82
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