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Article Title

Design and Implementation of a Clinician-Focused Intervention to Improve Diagnosis and Management of Symptomatic Vulvovaginal Atrophy in a Large Health System

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). However, despite the availability of effective treatment options, studies show that few women seek treatment for, and few providers ask women about, these symptoms. Our paired abstract describes clinician-reported barriers to diagnosis and management. Here we describe the prevalence of VVA diagnoses among women seen for well care within Kaiser Permanente Northwest (KPNW). We also describe the design of a clinician-focused intervention to improve diagnosis and management of symptomatic VVA.

Methods: Using electronic medical record (EMR) data, we identified well visits among women 55 years or older occurring within 17 KPNW primary care and OB/GYN clinics between June 2013 and May 2014. We computed the proportion of women who received a VVA-related diagnosis at the index visit. We then stratified the clinics based on visit volume and randomized them to an immediate versus delayed clinician-focused intervention. The intervention includes online and in-person education for clinicians regarding: 1) diagnosis and management of symptomatic VVA, and 2) new EMR-based clinical support tools (Smartsets and Smarttexts).

Results: We identified 14,274 unique well visits over the 1-year period of time. Of these, 80.5% (11,500/14,274) occurred in primary care. Only 5.7% (769/13,544) of visits by women not already using vaginal estrogen contained a VVA-related diagnosis. There are 371 clinicians; education for those in the intervention clinics is ongoing (Fall 2014). After the education period, we’ll prospectively collect EMR data to compare groups on the following outcomes: 1) proportion of well visits with VVA diagnoses; 2) proportion of women receiving vaginal estrogen prescriptions; and 3) proportion of visits that used the clinical support tools. We will also conduct an online survey of patients to determine if women in the intervention clinics are more likely than those in the control clinics to discuss VVA symptoms with their providers and to receive education and treatment options if symptomatic.

Discussion: The proportion of postmenopausal women with a VVA-related diagnosis was lower than expected. The purpose of our ongoing study is to evaluate whether active outreach to providers with education and clinical support tools leads to improved diagnosis and management of VVA.

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