Awareness of polycystic ovary syndrome among obstetrician-gynecologists and endocrinologists in Northern Europe

To date, little is known about differences in the knowledge, diagnosis making and treatment strategies of health care providers regarding polycystic ovary syndrome (PCOS) across different disciplines in countries with similar health care systems. To inform guideline translation, we aimed to study ph...

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Published in:	PloS one Vol. 14; no. 12; p. e0226074
Main Authors:	Piltonen, Terhi T, Ruokojärvi, Maria, Karro, Helle, Kujanpää, Linda, Morin-Papunen, Laure, Tapanainen, Juha S, Stener-Victorin, Elisabet, Sundrström-Poromaa, Inger, Hirschberg, Angelica L, Ravn, Pernille, Glintborg, Dorte, Mellembakken, Jan Roar, Steingrimsdottir, Thora, Gibson-Helm, Melanie, Vanky, Eszter, Andersen, Marianne, Arffman, Riikka K, Teede, Helena, Falah-Hassani, Kobra
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 26-12-2019 Public Library of Science (PLoS)
Subjects:	Adult Analysis Biology and Life Sciences Care and treatment Comorbidity Contraceptives Contraceptives, Oral - therapeutic use Cross-Sectional Studies Diagnosis Diagnostic systems Education Endocrinologists - psychology Endocrinology Europe Evidence-based medicine Female Fertility Gynecology Health care Hospitals Humans Life Style Lifestyles Male Management Medical diagnosis Medical disciplines: 700 Medical research Medicin och hälsovetenskap Medicine and Health Sciences Medisinske Fag: 700 Metabolism Metformin Metformin - therapeutic use Middle Aged Obstetrics Patients People and Places Physicians Physicians - psychology Pills Polycystic ovary syndrome Polycystic Ovary Syndrome - diagnosis Polycystic Ovary Syndrome - drug therapy Polycystic Ovary Syndrome - therapy Preventive medicine Psychotherapy Public health Questionnaires Regression Analysis Regression models Reproductive health Studies Surveys Surveys and Questionnaires VDP Europe Netherlands Sweden Norway Finland Denmark Iceland Estonia Northern Europe Melbourne Victoria Australia Australia
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Summary:	To date, little is known about differences in the knowledge, diagnosis making and treatment strategies of health care providers regarding polycystic ovary syndrome (PCOS) across different disciplines in countries with similar health care systems. To inform guideline translation, we aimed to study physician reported awareness, diagnosis and management of PCOS and to explore differences between medical disciplines in the Nordic countries and Estonia. This cross-sectional survey was conducted among 382 endocrinologists and obstetrician-gynaecologists in the Nordic countries and Estonia in 2015-2016. Of the participating physicians, 43% resided in Finland, 18% in Denmark, 16% in Norway, 13% in Estonia, and 10% in Sweden or Iceland, and 75% were obstetrician-gynaecologists. Multivariable logistic regression models were run to identify health care provider characteristics for awareness, diagnosis and treatment of PCOS. Clinical features, lifestyle management and comorbidity were commonly recognized in women with PCOS, while impairment in psychosocial wellbeing was not well acknowledged. Over two-thirds of the physicians used the Rotterdam diagnostic criteria for PCOS. Medical endocrinologists more often recommended lifestyle management (OR = 3.6, CI 1.6-8.1) or metformin (OR = 5.0, CI 2.5-10.2), but less frequently OCP (OR = 0.5, CI 0.2-0.9) for non-fertility concerns than general obstetrician-gynaecologists. The physicians aged <35 years were 2.2 times (95% CI 1.1-4.3) more likely than older physicians to recommend lifestyle management for patients with PCOS for fertility concerns. Physicians aged 46-55 years were less likely to recommend oral contraceptive pills (OCP) for patients with PCOS than physicians aged >56 (adjusted odds ratio (OR) = 0.4, 95% CI 0.2-0.8). Despite well-organized healthcare, awareness, diagnosis and management of PCOS is suboptimal, especially in relation to psychosocial comorbidities, among physicians in the Nordic countries and Estonia. Physicians need more education on PCOS and evidence-based information on Rotterdam diagnostic criteria, psychosocial features and treatment of PCOS, with the recently published international PCOS guideline well needed and welcomed.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 PLOS ONE Competing Interests: The authors have declared that no competing interests exist.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0226074