Abstract
BackgroundPolycystic ovary syndrome (PCOS) is a condition that affects women of reproductive age and manifests with adverse reproductive, metabolic and psychological consequences. Evidence-based PCOS guidelines recommend lifestyle management first line for infertility. In Singapore women with PCOS can attend the PCOS Clinic at the Kandang Kerbau Women and Children’s Hospital for infertility treatment. However lifestyle integration into infertility management is currently limited and barriers and enablers to progress remain unclear.MethodsAll PCOS clinic staff undertook semi-structured interviews to investigate perceived barriers for staff and consumers for the integration of lifestyle into infertility management. This study utilised various tools including an 8P Ishikawa diagram model to identify and categorise barriers. A modified Hanlon method was then used to prioritise barriers within the Singaporean context considering organisational, cultural and financial constraints. Propriety, economics, acceptability, resources and legality (PEARL) criteria were also incorporated into this decision-making tool.ResultsIn the 8P model, there were five factors contributing to the ‘procedure (consultations and referral processes)’ barrier, one ‘policy (government and hospitals)’ factor, five ‘place’ factors, two ‘product (lifestyle management programme)’ barriers, two ‘people (programme capacity)’ factors, four ‘process (integration)’ factors, three ‘promotion’ barriers and three ‘price’ factors. Of the prioritised barriers, two were identified across each of ‘procedures’, ‘place’, ‘product’ and ‘people’ and four related to ‘processes’. There were no barriers identified that for ‘policies’, ‘promotion’ and ‘price’ that can be addressed.ConclusionsThere is a clear need to integrate lifestyle into infertility management in PCOS, in line with current national and international evidence-based guidelines. The highest priority identified improvement opportunity was to develop a collaborative lifestyle management programme across hospital services. Reductions in variation of delivery and strengthening support within the lifestyle programme are other identified priorities. The strength of this study is that this is the first study to utilise a pragmatic quality improvement method for barriers identification and prioritisation in the area of lifestyle management for women with PCOS. This project identified factors that may provide easy improvements, but also identified some local factors that may be very difficult to change. The major limitation of this study is that it is only looking at the Singapore setting, so may have limited applicability to other countries. However, results from quality improvement projects are meant to be context specific.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-016-2107-2) contains supplementary material, which is available to authorized users.
Highlights
Polycystic ovary syndrome (PCOS) is a condition that affects women of reproductive age and manifests with adverse reproductive, metabolic and psychological consequences
The pragmatic QI accelerated model for improvement (AMI) methodology promoted by SingHealth department of Clinical Governance and Quality Management, Profound Knowledge Partners Inc [13], and Associates in Process Improvement [14, 15] was used for this exercise (Fig. 1)
There are three patients groups referred to the Kandang Kerbau Women’s and Children’s Hospital (KKH) PCOS Clinic from the KKH Infertility or KKH in vitro fertilisation (IVF) Clinics—patients who have infertility problems (Additional file 1: Figure S1), menstrual problems (Additional file 1: Figure S2), and/or ovulation problems (Additional file 1: Figure S3)
Summary
Polycystic ovary syndrome (PCOS) is a condition that affects women of reproductive age and manifests with adverse reproductive, metabolic and psychological consequences. Polycystic ovary syndrome (PCOS) is a condition affecting up to 18 % of reproductive-aged women [1] It manifests with adverse reproductive (hyperandrogenism, menstrual dysfunction, infertility and pregnancy complications) [1], metabolic (insulin resistance, dyslipidaemia, non-alcoholic fatty liver disease, endothelial dysfunction, early atherosclerosis and increased impaired glucose tolerance, type 2 diabetes mellitus and cardiovascular disease) [2], and psychological (worsened quality of life and increased anxiety and depression) [3]. A key clinical priority of the CPG was lifestyle (diet, exercise or behavioural) management to optimise weight management (defined as the prevention and treatment of excess weight) and the reproductive, metabolic and psychological features of PCOS delivered through multidisciplinary integrated care. Lifestyle management was prioritised for the treatment of infertility in PCOS
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