Document Type

Dissertation

Date of Degree

Spring 2021

Keywords

Polycystic Ovary Syndrome, Adolescents, Diagnosis, Treatment, Management, Primary Care, Pediatric, Family Medicine

Abstract

Background: Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder in women of reproductive age, associated with complications of metabolic, reproductive, and psychological health. Adolescence is an optimal time for early identification of PCOS in order to mitigate long-term health risks. Pediatric primary care providers (pedPCPs) are the first-line for early identification and coordination of longterm comprehensive management. Limited information exists to describe how PCOS is addressed in primary care and if adolescent-specific guidelines are applied.

Objectives: Describe practice behaviors of pedPCPs in the diagnosis and management of PCOS, and identify barriers and facilitators to inform future interventions to optimize comprehensive care for adolescents with PCOS.

Methods: A mixed-methods sequential explanatory design included survey research and semi-structured interviews. A barrier assessment framework, combined with behavior change models, underpin the conceptual framework that guided survey development. Snowball sampling recruited physicians, physician assistants and nurse practitioners in primary care in Virginia, Maryland and Washington D.C. through professional associations and academic institutions. Descriptive statistical analysis of survey data was conducted utilizing SPSS. Respondents from the survey research who volunteered for follow up participated in 1:1 semi-structured interviews, which were audio recorded, transcribed verbatim and coded. Nvivo 12 was used to code using thematic analysis.

Results: Fifty-two completed survey responses were analyzed for practice behaviors and attitudes/beliefs. Qualitative data from 20 interviews offered rich descriptions of pedPCPs’ experience in addressing PCOS. Integration of the quantitative and qualitative results demonstrated that level of engagement to address PCOS varied among pedPCPs. Differences in provider confidence, collaboration with colleagues and/or specialists, practice structure and policies, and pedPCPs’ perception of patient factors explain some variations observed across practices.

Conclusion: PedPCPs play an important role in the identification and management of PCOS in adolescence. Research results provide a model to map intervention components that will overcome barriers and enhance facilitators to address PCOS in primary care. Interventions should include case based learning and a platform for pedPCPs to collaborate with experts. Improving the capacity of pedPCPs to diagnose and manage PCOS is key to optimize care for adolescents and reduce risks of immediate and long-term complications of PCOS.

Comments

©2021 by J. Leocadia Conlon. All rights reserved.

Open Access

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