Cornerstone Clinic for Women embraces telehealth to expand patient access

Women can spend half their lives in menopause, and yet a 2013 survey showed only about one in five OB-GYN residents receives formal training in menopause. Jaclyn "Jackie" Piasta, APRN, Cornerstone Clinic for Women (CCFW), Little Rock, is the only nurse practitioner in the state who is a National Certified Menopause Practitioner by the North American Menopause Society. Seven Arkansas physicians also have that designation.

Piasta is passionate about spreading awareness on the safety of hormone replacement therapy (HRT) and dispelling fears among providers and patients. Twenty years ago, the Women's Health Initiative study linked HRT to increased risk of breast cancer leading to a 70 percent reduction in HRT prescriptions. But since that time, researchers have walked back nearly every conclusion in that study.

"But that doesn't make the news, so fear and outdated knowledge persist," Piasta said, who has revamped the menopause curriculum at her alma mater, Vanderbilt University School of Nursing. "Unfortunately, there is a gap in menopause knowledge among clinicians and with 1.3 million women entering menopause every year, this is a real concern. Hormones have a huge impact on our entire bodies. There are more than 30 different symptoms associated with menopause including insomnia, night sweats, hot flashes, brain fog, heart palpitations, vaginal dryness, mood swings, anxiety and depression. HRT can be massively beneficial for these, yet many women suffer out of fear of HRT or provider unwillingness to prescribe."

Piasta said when it comes to HRT, we tend to focus on the risk of breast cancer when scientific research does not provide good evidence that taking any type of HRT at any age significantly increases the risk of developing breast cancer.

"I teach my patients that current guidelines state, for most women, if you are within ten years of menopause, the benefits of HRT outweigh the risks," Piasta said. "Women with a personal history of breast cancer are an exception to this along with a few other medical conditions. However, there are other therapies available. That's why it is so important to personalize care."

What Piasta really likes to talk about is how to live your best years in menopause.

"When I see a patient transitioning into menopause or already a few years in, I know her health is the best it will ever be going forward," she said. "That's why I think it's so important to be proactive. It is important for providers and patients to be aware that menopause is associated with a variety of health concerns including cardiovascular disease (CVD), osteoporosis, dementia, UTIs, and depression," said Piasta. "The three heavy hitters in my opinion are CVD, dementia and osteoporosis. Lifestyle improvements and HRT both have a positive impact on these diseases."

Cardiovascular disease is the number one killer of women, while two thirds of Alzheimer's patients are women. Additionally, one in two women over age of 50 will sustain an osteoporotic fracture in their lifetime.

"We can use estrogen to help prevent this from happening," Piasta said. "How amazing is that? And the sooner we can impart this knowledge to patients the better."

Piasta looks at many different factors including personal and family medical history before making recommendations. While HRT is recommended within ten years of menopause, it can also be considered beyond ten years.

"When someone comes to see me, I have to take into consideration so much more than their age," Piasta said. "I work with each woman to determine her goals and pair that with complementary therapies. Whether she initiates HRT is just one small piece of a much bigger picture."

There are also other options Piasta explains including supplements, antidepressants and other non-hormonal pharmaceuticals, and lifestyle changes.

Piasta is a certified yoga instructor who practices what she preaches. She weaves the teachings of yoga into her patient care. She believes in the importance of self-care and the mind-body connection. By being an example to her patients she feels it often encourages them to invest in their health.

"Mindfulness and meditation are so important because we let the hustle and bustle take over," she said.

Women can find it difficult to get appointments with women's health specialists in Arkansas because of a shortage of providers. Piasta said NPs are playing an important role in providing care.

"I know our NPs at CCFW are a major part of why we function so well," she said. "We have ten APRNs and one PA on staff to help accommodate more patients. Many of us have even developed our own niches with long waiting lists to answer demand for issues like functional medicine and hormones. We have two NPs who do urogynecology and four of us specializing in hormones/menopause. Patients could have anywhere between a 1-3 month wait to be seen. I hope more clinicians will expand their practice knowledge to meet these needs."

To improve patient access for women who need to be seen quickly, CCFW has established a Women's Urgent Care center in Little Rock. Telehealth is another option.

"Telehealth is a huge passion of mine that allows me to expand access and see more people, especially for things that don't necessarily require an in-office visit," she said. "When consults can be done with telehealth, it increases compliance. Bringing healthcare to someone's living room is a great tool."

Piasta said she has been blessed to work with a lot of exceptional physician mentors throughout her career, including well-known OB-GYN Dr. Kay Chandler at CCFW.

"Dr. Chandler's reputation speaks for itself," Piasta said. "She is a great leader. She can see the talents of others and really enjoys lifting others up to their full potential. She is curious and always wants to bring the newest and best treatments for patients. It's a pleasure working with her."

In addition to menopause and hormones, Piasta specializes in metabolic health, sex medicine and general gynecology using a holistic approach. She is one of only three members of the International Society for the Study of Women's Sexual Health in the state. She is active with Nurse Practitioners in Women's Health and currently on the abstract review committee for this year's annual meeting.

Piasta never considered anything but a career in healthcare. Her mother, Dr. Kathleen Miller, is scientific lab director for several infertility clinics and runs a successful IVF consulting firm.

"I grew up in her footsteps and was raised in a medical practice. I've done just about every job there is," she said. "I could see the intimate relationship with patients coupled with science and innovation. It is an excellent place to make a big impact in people's lives."

Piasta and her husband, Steve, a pilot for Delta Air Lines, have two daughters, Harper, 6, and Charlotte, 4.

"My daughters are the light of my life," Piasta said. "My family loves the Natural State exploring outdoor hiking and biking. Pinnacle Mountain is probably our favorite weekend quick trip. We are a very active family."

To reach the CCFW, call 501.224.5500 or visit the website https://www.cornerstoneclinicforwomen.com/