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Article Title

Design and Implementation of a Clinician-Focused Intervention to Improve Diagnosis and Management of Symptomatic Vulvovaginal Atrophy: Clinician-Reported Barriers

Publication Date

4-30-2015

Keywords

patient care improvement, postmenopause

Abstract

Background/Aims: Nearly 50% of postmenopausal women experience symptoms related to vulvovaginal atrophy (VVA) including vulvovaginal dryness and irritation, painful intercourse, dysuria, urinary urgency and incontinence, and recurrent urinary tract infection. Effective treatment options are available, however few women seek treatment for these symptoms and few providers ask women if they are symptomatic. As part of the development of a clinician-focused intervention to improve diagnosis and management of symptomatic VVA among Kaiser Permanente Northwest patients, we conducted a survey of primary care and OB/GYN clinicians to assess provider knowledge about VVA and barriers to its diagnosis and treatment.

Methods: We sent an email invitation to take a short online survey to all 353 Kaiser Permanente Northwest primary care and OB/GYN clinicians with valid email addresses. The survey included VVA knowledge questions related to symptoms, diagnosis and treatment, and practice assessment questions. We asked clinicians to report all potential barriers to VVA diagnosis and treatment in their practice. A list of potential barriers and an open-ended response option were provided.

Results: The response rate was 34% (120/353). Knowledge about VVA was good; 67% (641/953) of responses were correct. Only 39.5% (47/119) of clinicians were likely to assess VVA in a postmenopausal patient if she did not mention symptoms. Most clinicians rated their confidence in counseling their patients as medium or less regarding menopause-related vaginal discomfort (56.1%; 67/118) and the risks/benefits of vaginal estrogen therapy (58%; 69/119). Commonly reported barriers were lack of time during the visit (75.4%; 86/114), lack of patient education materials (45.6%; 52/114) and clinical tools (18.4%; 21/114), patient discomfort with discussing vulvovaginal concerns (41.2%; 47/114), warnings about risks of estrogen medication in elderly women (36.8%; 42/114), and the clinicians’ lack of knowledge about VVA (32.5%; 37/114).

Discussion: Provider knowledge about VVA symptoms and treatment is generally good. Barriers to patient care such as time, lack of clinical support tools, and patient-provider discomfort with discussion of VVA may explain why this easily treated condition is frequently underdiagnosed and undertreated. Our second abstract describes the intervention phase of our study, which includes the design and implementation of a clinician-focused intervention to improve diagnosis and management of symptomatic VVA.

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