36. Primary Care Provider Behaviors, Attitudes and Beliefs In the Diagnosis and Management of Polycystic Ovary Syndrome in Adolescents

Abstract

<h3>Background</h3> Pediatric Primary Care Providers (pedPCPs) are often the first line for identification of polycystic ovary syndrome (PCOS) in adolescents. No empirical research has systematically evaluated pedPCPs behaviors, and their role in the diagnosis and management of PCOS in adolescents. Aim 1. Develop a survey instrument that evaluates current practice behaviors among pedPCPs in the diagnosis and management of PCOS. Aim 2. Identify current practice behaviors and attitudes/beliefs about PCOS among pedPCPs. <h3>Methods</h3> A survey instrument used to measure knowledge in diagnosing and managing PCOS among gynecologists and reproductive endocrinologists was adapted for primary care providers. Additional questions regarding attitudes/beliefs were created utilizing a conceptual framework combining the Health Belief Model and Theory of Planned Behavior. This IRB exempt study utilized Cognitive Validity Interviews to verify clarity and understanding of the survey instrument. The finalized survey was administered online. Snowball sampling was used to recruit physicians, physician assistants and nurse practitioners in primary care practices in Virginia, Maryland and Washington D.C. through professional associations and academic institutions. Descriptive statistical analysis of survey data was done utilizing SPSS. <h3>Results</h3> Fifty-two completed survey responses were analyzed for practice behaviors, attitudes and beliefs. Eighteen respondents (35%) practice in pediatric medicine and 34 (65%) practice in family medicine. Forty-four (85%) respondents indicated they have adolescent patients with PCOS, but 6 do not make the diagnosis. Twenty-nine (29/44, 66%) stated that they actively treat PCOS and 30 (30/44, 68%) screened for complications of PCOS. See figure 1. for treatment selections. Thirty-eight (86%) pedPCPs indicated that they refer adolescents with PCOS to specialists for some or all aspects of care. Six respondents who did not refer reported confidence in their management of PCOS. Sixteen statements regarding attitudes/beliefs about PCOS in adolescents were rated by participants for their level of agreement based on a 5-point Likert Scale. Cronbach's alpha test to determine internal consistency of the items demonstrated high reliability with a score of .795. Table 1 identifies items with the highest and lowest mean item score for agreement. <h3>Conclusions</h3> The majority of pedPCPs in this sample engage in some aspects of diagnosis or treatment of PCOS with varying involvement levels. Differences in belief about ability to diagnosis and manage PCOS may explain some practice variations. Qualitative studies could help to better understand barriers and facilitators to addressing PCOS and explore nuances in pedPCPs practice and collaboration with specialists.