Models of care on the management of women with polycystic ovary syndrome: A multicentre study.

PURPOSE: International recommendations on the treatment of polycystic ovary syndrome (PCOS) advocate comprehensive assessment, risk stratification, and patient-centred education at first presentation; however, implementation within real-world Models of Care (MoCs) remains poorly understood. This study aimed to characterise PCOS MoCs, assess alignment with international recommendations, and examine variability in investigations at first specialist consultation. METHODS: We conducted a multicentre observational mixed-methods evaluation across eight secondary-care centres in five countries. Qualitative clinician interviews described MoC structures, staffing, referral pathways, and documentation practices. Quantitative analysis of retrospective clinical records from women attending their first PCOS consultation between January 2020 and December 2023 (n = 1,321) assessed completion of guideline-recommended biochemical investigations. MoCs were evaluated using the Donabedian framework and the Chronic Care Model (CCM), mapped across ten domains of the 2023 International PCOS Guidelines. RESULTS: Substantial heterogeneity in PCOS MoCs was observed within and across countries. Documentation of emotional well-being screening (9.4–17.6%) and long-term cardiometabolic risk education (0.7–29.9%) was low. Donabedian analysis identified structural determinants—including funding models, multidisciplinary team availability, administrative support, and clinic organisation—as key drivers of variation in care processes. CCM mapping demonstrated limited decision support, weak care coordination, and minimal reinforcement of patient self-management. Centres with established multidisciplinary teams and structured follow-up pathways showed greater guideline alignment and more complete biochemical assessment. CONCLUSION: Variation in PCOS care delivery is driven by systemic structural differences rather than clinical judgment. Strengthening multidisciplinary capacity and embedding CCM-aligned processes are essential to improve guideline adherence and support equitable, person-centred PCOS care.