Determinants of Health Care Dissatisfaction among a US Population-based Cohort of Women with Polycystic Ovary Syndrome.

Context: The 2018 International Evidence Based Guidelines (IEBG) for PCOS were created, in part, in response to poor patient satisfaction on international surveys. Patient satisfaction in the US, before and after these guidelines has not yet been characterized.

Objective: To evaluate care patterns and patient attitudes among women with PCOS in the US before and after IEBG.

Design: Cross-sectional.

Setting: A population-based community sample of women in the US.

Patients Or Other Participants: Women with PCOS confirmed by a care provider.

Interventions: None.

Main Outcome Measures: Standardized questionnaires on care patterns and satisfaction in care.

Results: 1056 respondents, aged 23±6 years at diagnosis were included. 69.2% had to wait >1 year and 72.9% saw >1 provider prior to receiving a diagnosis. <45% strongly agreed or agreed with statements regarding trusting their doctor. <27% were very or somewhat satisfied with care across all questions. In multivariable analyses, composite outcome of trusting your physician was associated with insurance type (uninsured vs private) (OR (95% CI), 0.5 (0.3-0.9), p=0.020)), race (Hispanic vs Caucasian) (0.6 (0.5-0.9), p=0.007), (Black vs Caucasian) (1.6 (1.0-2.4), p=0.045) and timing of diagnosis (within 5 years vs >5 years) (1.3 (1.0-1.7), p=0.038). Care satisfaction was associated with insurance type (public vs private) (0.6 (0.4-0.9), p=0.010), (uninsured vs private) (0.5 (0.3-0.9), p=0.021), and timing of diagnosis (within 5 years vs >5 years) (1.4 (1.1-1.9), p=0.010).

Conclusions: Satisfaction and trust in care is overall poor among patients with PCOS in the US. Higher scores among those diagnosed within the past 5 years, compared to those with a more remote diagnosis, may indicate an improving trend in care.