Role of the Dietitian in Multidisciplinary Treatment of Polycystic Ovary Syndrome

Abstract

Role of the Dietitian in Multidisciplinary Treatment of Polycystic Ovary Syndrome Wendy Thompson Background: Polycystic Ovary Syndrome (PCOS) is the most common reproductive endocrine disorder in females. Genetic and lifestyle factors influence the etiology and insulin resistance plays a key role in the pathogenesis of PCOS. Objective: To investigate the current trends and future implications of multidisciplinary PCOS clinics while emphasizing the role and challenges for dietitians. Methods: The study design was a two-phase formative investigation of PCOS focused practitioners through an anonymous, internet-based survey (Qualtrics, Provo, UT) followed by focus groups done via teleconference. Focus group data was analyzed using Braun and Clarke's method of thematic analysis. Participants: Survey respondents included 261 health care providers, 59% physicians, 20% dietitians, from around the world (64% from the United States); the majority (59%) represented multidisciplinary facilities. Focus group participants included four dietitians, three physicians, a health psychologist and a licensed nutritionist that had 7-25 years of experience treating PCOS. Results: From the survey, the barriers for future multidisciplinary clinics included: money/resources, insurance reimbursement, and difference of opinions; the potential advantages included: more comprehensive and integrated care, greater convenience/efficiency, better longterm outcomes, and increased access to disciplines. Dietitians were involved in 71% of the clinics represented in the survey and 89% of respondents stated that dietitians need to be 'involved' or 'highly involved' in PCOS treatment. Focus group participants stated the greatest challenges for dietitians include insurance, lack of PCOS knowledge, and lack of physician referrals. Overall, nutritional interventions are not very accessible for the majority of PCOS patients. Conclusions and Implications: 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.