Management of thyroid dysfunction by primary care physicians of the Province of Quebec: a transversal study

This study aims to evaluate clinical practice of primary care physicians regarding common thyroid disorders. A sample of 210 primary care physicians was randomly selected in three Quebec's administrative regions. Four clinical vignettes (V1 to V4) were presented by mail: two cases of subclinica...

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Bibliographic Details
Published in:Annales d'endocrinologie 2008-06, Vol.69 (3), p.210-217
Main Authors: Gagnon, F, Lareau-Trudel, E, Bachand, M-P, Hamel, C, Lapointe, V, Dubois, M-F, Xhignesse, M, Langlois, M-F
Format: Article
Language:eng ; fre
Subjects:
Adult
Aged
Female
Humans
Hypothyroidism - therapy
Medicine
Middle Aged
Physicians, Family
Quebec
Referral and Consultation
Specialization
Surveys and Questionnaires
Thyroid Diseases - therapy
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Summary:This study aims to evaluate clinical practice of primary care physicians regarding common thyroid disorders. A sample of 210 primary care physicians was randomly selected in three Quebec's administrative regions. Four clinical vignettes (V1 to V4) were presented by mail: two cases of subclinical hypothyroidism (women of 25 years - V1 - and 70 - V2 - years of age) for which physicians had to choose to either treat or not with thyroid replacement and two cases of hyperthyroidism (women of 30 - V3 - and 66 - V4- years of age) for which they had to choose a course of action (observation, treatment or referral to a specialist). V1 and V2 where followed by four sub-questions presenting supportive elements that could influence the decision to treat (presence of antithyroid antibodies, accumulation of symptoms, LDL cholesterol and thyreostimulin levels). The overall response rate was 22%. Forty-two percent of respondents would have treated V1 outright and 49% would have treated V2. The therapeutic approach in the face of these two vignettes, independently of the presence or absence of supportive clinical or biochemical elements, did not vary according to geographic practice area. However, one region was significantly more conservative for V4. The number of years in practice or assistance to continuous medical education activities did not affect management of vignettes. This study outlines the importance of clinical practice guidelines and tools to facilitate their application in clinical management of thyroid disorders.
ISSN:0003-4266
DOI:10.1016/j.ando.2008.01.005