Semin Reprod Med 2018; 36(01): 086-094
DOI: 10.1055/s-0038-1667310
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Integrated Model of Care for Polycystic Ovary Syndrome

Chau T. Tay
1   Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
2   Department of Diabetes and Vascular Medicine, Monash Health, Victoria, Australia
,
Lisa J. Moran
1   Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
,
Chandrika N. Wijeyaratne
3   Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
,
Leanne M. Redman
4   Reproductive Endocrinology and Women's Health Research Program, Pennington Biomedical Research Centre, Baton Rouge, Louisiana
,
Robert J. Norman
5   Department of Obstetrics and Gynaecology, Robinson Research Institute, University of Adelaide, South Australia, Australia
,
Helena J. Teede
1   Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
2   Department of Diabetes and Vascular Medicine, Monash Health, Victoria, Australia
,
Anju E. Joham
1   Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
2   Department of Diabetes and Vascular Medicine, Monash Health, Victoria, Australia
› Author Affiliations
Further Information

Publication History

Publication Date:
06 September 2018 (online)

Abstract

Polycystic ovary syndrome (PCOS) affects approximately one in seven women worldwide from early adulthood with heterogeneity in their healthcare needs through the life cycle. PCOS is challenging to diagnose and manage, with one-third of women reporting at least a 2-year delay in diagnosis. Current clinical services do not satisfactorily educate and support women with their diverse reproductive, metabolic, and psychological care needs with fragmentation of services across health providers. Women are dissatisfied with the care they received, while the first contact general practitioners often feel ill-equipped to diagnose and manage PCOS. Despite national evidence-based guidelines recommending integrated multidisciplinary services, guideline translation has been limited, with wide practice variation and no optimal models of care. Lifestyle management and psychological support are the cornerstones of care and health providers who most commonly manage PCOS (general practitioners, dermatologists, endocrinologists, and gynecologists) require appropriate resources and multidisciplinary support. An evidence-based patient-centered clinical model of care, codeveloped by consumers and health professionals that provides education and resources and offers multidisciplinary holistic care, is vital to support women with PCOS.

 
  • References

  • 1 Bozdag G, Mumusoglu S, Zengin D, Karabulut E, Yildiz BO. The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod 2016; 31 (12) 2841-2855
  • 2 March WA, Moore VM, Willson KJ, Phillips DI, Norman RJ, Davies MJ. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod 2010; 25 (02) 544-551
  • 3 Teede H, Michelmore J, McCallister V, Norman RJ. Evidence-based guideline for the assessment and management of polycystic ovary syndrome. PCOS Australian Alliance; 2011
  • 4 Teede HLJ, Moran L, Dokras A, Misso ML, Piltonin T, Costello M, Norman R. On Behalf of the International PCOS Network. International Evidence-Based Guidelines for the Assessment and Management of Polycystic Ovary Syndrome. Melbourne, Australia; 2018
  • 5 Avery JC, Braunack-Mayer AJ. The information needs of women diagnosed with polycystic ovarian syndrome–implications for treatment and health outcomes. BMC Womens Health 2007; 7: 9
  • 6 Gibson-Helm ME, Lucas IM, Boyle JA, Teede HJ. Women's experiences of polycystic ovary syndrome diagnosis. Fam Pract 2014; 31 (05) 545-549
  • 7 Kumarapeli V, Seneviratne RdeA, Wijeyaratne C. Health-related quality of life and psychological distress in polycystic ovary syndrome: a hidden facet in South Asian women. BJOG 2011; 118 (03) 319-328
  • 8 Schmid J, Kirchengast S, Vytiska-Binstorfer E, Huber J. Infertility caused by PCOS--health-related quality of life among Austrian and Moslem immigrant women in Austria. Hum Reprod 2004; 19 (10) 2251-2257
  • 9 Jejeebhoy S, Koenig M. The social context of gynaecological morbidity, correlates, consequences and health seeking behaviour. In: Jejeebhoy S, Koenig M, Elias C. , eds. Research Approaches to the Study of Reproductive Tract Infections and Other Gynaecological Disorders-Multidisciplinary Research Approach. 1 ed. Cambridge: Cambridge University Press; 2003: 30-81
  • 10 Jeanes YM, Barr S, Smith K, Hart KH. Dietary management of women with polycystic ovary syndrome in the United Kingdom: the role of dietitians. J Hum Nutr Diet 2009; 22 (06) 551-558
  • 11 Moran LJ, Brown WJ, McNaughton SA, Joham AE, Teede HJ. Weight management practices associated with PCOS and their relationships with diet and physical activity. Hum Reprod 2017; 32 (03) 669-678
  • 12 Osborne RH, Elsworth GR, Whitfield K. The Health Education Impact Questionnaire (heiQ): an outcomes and evaluation measure for patient education and self-management interventions for people with chronic conditions. Patient Educ Couns 2007; 66 (02) 192-201
  • 13 Davies MJ, Marino JL, Willson KJ, March WA, Moore VM. Intergenerational associations of chronic disease and polycystic ovary syndrome. PLoS One 2011; 6 (10) e25947
  • 14 Moran LJ, Pasquali R, Teede HJ, Hoeger KM, Norman RJ. Treatment of obesity in polycystic ovary syndrome: a position statement of the Androgen Excess and Polycystic Ovary Syndrome Society. Fertil Steril 2009; 92 (06) 1966-1982
  • 15 Mann L. From “silos” to seamless healthcare: bringing hospitals and GPs back together again. Med J Aust 2005; 182 (01) 34-37
  • 16 Gibson-Helm M, Teede H, Dunaif A, Dokras A. Delayed diagnosis and a lack of information associated with dissatisfaction in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2017; 102 (02) 604-612
  • 17 Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 2004; 19 (01) 41-47
  • 18 Powers SE, Uliassi NW, Sullivan SD, Tuchman LK, Mehra R, Gomez-Lobo V. Trends in standard workup performed by pediatric subspecialists for the diagnosis of adolescent polycystic ovary syndrome. J Pediatr Adolesc Gynecol 2015; 28 (01) 43-46
  • 19 Dokras A, Saini S, Gibson-Helm M, Schulkin J, Cooney L, Teede H. Gaps in knowledge among physicians regarding diagnostic criteria and management of polycystic ovary syndrome. Fertil Steril 2017; 107 (06) 1380-1386.e1
  • 20 WHO Regional Office for Europe. Integrated Care Models: An Overview. Copenhagen: World Health Organization; 2016
  • 21 WHO Regional Office for Europe. Strengthening People-Centred Health Systems in the WHO European Region: Framework for Action on Integrated Health Services Delivery. Copenhagen: World Health Organization; 2016
  • 22 Busetto L, Luijkx KG, Elissen AMJ, Vrijhoef HJM. Context, mechanisms and outcomes of integrated care for diabetes mellitus type 2: a systematic review. BMC Health Serv Res 2016; 16: 18
  • 23 Desmedt M, Vertriest S, Hellings J. , et al. Economic impact of integrated care models for patients with chronic diseases: a systematic review. Value Health 2016; 19 (06) 892-902
  • 24 Everink IHJ, van Haastregt JCM, Evers SMAA, Kempen GIJM, Schols JMGA. An economic evaluation of an integrated care pathway in geriatric rehabilitation for older patients with complex health problems. PLoS One 2018; 13 (02) e0191851
  • 25 Lemmens KM, Lemmens LC, Boom JH. , et al. Chronic care management for patients with COPD: a critical review of available evidence. J Eval Clin Pract 2013; 19 (05) 734-752
  • 26 Peña-Sánchez JN, Lix LM, Teare GF, Li W, Fowler SA, Jones JL. Impact of an integrated model of care on outcomes of patients with inflammatory bowel diseases: evidence from a population-based study. J Crohn's Colitis 2017; 11 (12) 1471-1479
  • 27 Zhang J, Donald M, Baxter KA. , et al. Impact of an integrated model of care on potentially preventable hospitalizations for people with Type 2 diabetes mellitus. Diabet Med 2015; 32 (07) 872-880
  • 28 World Health Organization. WHO Global Strategy on People-Centred and Integrated Health Services. Geneva: World Health Organization; 2015
  • 29 Borgermans L, Marchal Y, Busetto L. , et al. How to improve integrated care for people with chronic conditions: key findings from EU FP-7 project INTEGRATE and beyond. Int J Integr Care 2017; 17 (04) 7
  • 30 Teede H, Deeks A, Moran L. Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Med 2010; 8: 41
  • 31 Jeddi FR, Nabovati E, Amirazodi S. Features and effects of information technology-based interventions to improve self-management in chronic kidney disease patients: a systematic review of the literature. J Med Syst 2017; 41 (11) 170
  • 32 Lombard CB, Harrison CL, Kozica SL, Zoungas S, Keating C, Teede HJ. Effectiveness and implementation of an obesity prevention intervention: the HeLP-her Rural cluster randomised controlled trial. BMC Public Health 2014; 14: 608
  • 33 Cooney LG, Lee I, Sammel MD, Dokras A. High prevalence of moderate and severe depressive and anxiety symptoms in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod 2017; 32 (05) 1075-1091
  • 34 Bazarganipour F, Ziaei S, Montazeri A, Foroozanfard F, Kazemnejad A, Faghihzadeh S. Body image satisfaction and self-esteem status among the patients with polycystic ovary syndrome. Iran J Reprod Med 2013; 11 (10) 829-836
  • 35 Lee I, Cooney LG, Saini S. , et al. Increased risk of disordered eating in polycystic ovary syndrome. Fertil Steril 2017; 107 (03) 796-802
  • 36 Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: executive summary. Expert Panel on the Identification, Evaluation, and Treatment of Overweight in Adults. Am J Clin Nutr 1998; 68 (04) 899-917
  • 37 NHMRC. Clinical Guidelines for Weight Control and Obesity Management in Adults. Canberra, Australia: National Health and Medical Research Council; 2002
  • 38 Crosignani PG, Colombo M, Vegetti W, Somigliana E, Gessati A, Ragni G. Overweight and obese anovulatory patients with polycystic ovaries: parallel improvements in anthropometric indices, ovarian physiology and fertility rate induced by diet. Hum Reprod 2003; 18 (09) 1928-1932
  • 39 Thomson RL, Buckley JD, Lim SS. , et al. Lifestyle management improves quality of life and depression in overweight and obese women with polycystic ovary syndrome. Fertil Steril 2010; 94 (05) 1812-1816
  • 40 Tolino A, Gambardella V, Caccavale C. , et al. Evaluation of ovarian functionality after a dietary treatment in obese women with polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol 2005; 119 (01) 87-93
  • 41 Kushner RF. Barriers to providing nutrition counseling by physicians: a survey of primary care practitioners. Prev Med 1995; 24 (06) 546-552
  • 42 Noordman J, Koopmans B, Korevaar JC, van der Weijden T, van Dulmen S. Exploring lifestyle counselling in routine primary care consultations: the professionals' role. Fam Pract 2013; 30 (03) 332-340
  • 43 Knowler WC, Barrett-Connor E, Fowler SE. , et al; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346 (06) 393-403
  • 44 NHMRC. Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults, Adolescents and Children in Australia: Systematic Review. Melbourne, Australia: National Health and Medical Research Council; 2013
  • 45 Azziz R, Carmina E, Dewailly D. , et al; Task Force on the Phenotype of the Polycystic Ovary Syndrome of The Androgen Excess and PCOS Society. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril 2009; 91 (02) 456-488
  • 46 Ekbäck MP, Lindberg M, Benzein E, Årestedt K. Health-related quality of life, depression and anxiety correlate with the degree of hirsutism. Dermatology 2013; 227 (03) 278-284
  • 47 Joham AE, Teede HJ, Ranasinha S, Zoungas S, Boyle J. Prevalence of infertility and use of fertility treatment in women with polycystic ovary syndrome: data from a large community-based cohort study. J Womens Health (Larchmt) 2015; 24 (04) 299-307
  • 48 Palomba S, de Wilde MA, Falbo A, Koster MP, La Sala GB, Fauser BC. Pregnancy complications in women with polycystic ovary syndrome. Hum Reprod Update 2015; 21 (05) 575-592
  • 49 Qin JZ, Pang LH, Li MJ, Fan XJ, Huang RD, Chen HY. Obstetric complications in women with polycystic ovary syndrome: a systematic review and meta-analysis. Reprod Biol Endocrinol 2013; 11: 56
  • 50 Bahri Khomami M, Boyle JA, Tay CT. , et al. Polycystic ovary syndrome and adverse pregnancy outcomes: current state of knowledge, challenges and potential implications for practice. Clin Endocrinol (Oxf) 2018; 88 (06) 761-769
  • 51 Steiner AZ, Jukic AM. Impact of female age and nulligravidity on fecundity in an older reproductive age cohort. Fertil Steril 2016; 105 (06) 1584-1588.e1
  • 52 de Groot PC, Dekkers OM, Romijn JA, Dieben SW, Helmerhorst FM. PCOS, coronary heart disease, stroke and the influence of obesity: a systematic review and meta-analysis. Hum Reprod Update 2011; 17 (04) 495-500
  • 53 Hart R, Doherty DA. The potential implications of a PCOS diagnosis on a woman's long-term health using data linkage. J Clin Endocrinol Metab 2015; 100 (03) 911-919
  • 54 Moran LJ, Misso ML, Wild RA, Norman RJ. Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update 2010; 16 (04) 347-363
  • 55 Legro RS, Arslanian SA, Ehrmann DA. , et al; Endocrine Society. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2013; 98 (12) 4565-4592
  • 56 Wild RA, Carmina E, Diamanti-Kandarakis E. , et al. Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. J Clin Endocrinol Metab 2010; 95 (05) 2038-2049
  • 57 Azziz R, Carmina E, Chen Z. , et al. Polycystic ovary syndrome. Nat Rev Dis Primers 2016; 2: 16057
  • 58 Boyle J, Hollands G, Beck S. , et al. Process evaluation of a pilot evidence-based Polycystic Ovary Syndrome clinic in the Torres Strait. Aust J Rural Health 2017; 25 (03) 175-181
  • 59 Kilkenny M, Churilov L, Cadilhac DA. Risk-adjusted hospital mortality rates for stroke: evidence from the Australian Stroke Clinical Registry (AuSCR). Med J Aust 2017; 207 (07) 315-316
  • 60 Zoungas SPA, Ranasinha S, Earnest A. , et al. Australian National Diabetes Audit – Australian Quality Clinical Audit 2017 Final Report. Australian National Diabetes Audit – Australian Quality Clinical Audit 2017 Final Report. Australia: Australian Government Department of Health; 2017