Division of Metabolism, Endocrinology, and Diabetes (MEND), Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan 48109, USA.
Thyroid. 2010 Mar;20(3):301-7. doi: 10.1089/thy.2009.0321.
Clinical guidelines have a role in medical education and in the standardization of patient care. However, it is not clear whether guidelines created by subspecialists reach relevant practicing physicians or influence patient care. In 2007 the Endocrine Society released "Guidelines on the Management of Thyroid Dysfunction During Pregnancy and Postpartum." The objective of this study was to characterize the role of these guidelines in provider education and in subsequent patient care decisions.
In 2009 three waves of mail surveys were distributed to 1601 Wisconsin health care providers with a history of providing obstetric care. Survey participants were members of the American College of Obstetricians and Gynecologists or the American Academy of Family Physicians. There were 881 returned surveys (55%) and 575 were eligible for the study (adjusted rate 52.5%).
Although only 11.5% of providers read the Endocrine Society's guidelines, reading the guidelines was associated with increased likelihood of prepregnancy counseling on levothyroxine management (p < 0.0001), increased likelihood of screening for thyroid disease risk factors (p = 0.0007), and increased likelihood of empiric levothyroxine dose increase in pregnant patients (p = 0.0005). After controlling for provider sex, membership affiliation, practice setting, and number of years in practice, reading the guidelines was still an independent predictor of patient education prepregnancy (p < 0.01).
The Endocrine Society's "Guidelines on the Management of Thyroid Dysfunction During Pregnancy and Postpartum" reached a minority of providers involved in obstetrics, but exposure to the guidelines did impact patient care. A multidisciplinary approach to guideline creation would improve the dissemination and practical application of guidelines.
临床指南在医学教育和规范患者护理方面发挥着作用。然而，目前尚不清楚由专科医生制定的指南是否能接触到相关的执业医师，或是否会影响患者的护理。2007 年，内分泌学会发布了《妊娠和产后甲状腺功能障碍管理指南》。本研究的目的是描述这些指南在提供者教育以及随后的患者护理决策中的作用。
2009 年，向 1601 名有产科护理史的威斯康星州医疗保健提供者分三批邮寄了调查问卷。调查参与者均为美国妇产科医师学会或美国家庭医师学会的成员。共收到 881 份回复调查问卷（55%），其中 575 份符合研究条件（调整后的回复率为 52.5%）。
尽管只有 11.5%的提供者阅读了内分泌学会的指南，但阅读该指南与增加备孕时左旋甲状腺素管理咨询的可能性（p < 0.0001）、增加甲状腺疾病危险因素筛查的可能性（p = 0.0007）和增加妊娠患者经验性左旋甲状腺素剂量的可能性（p = 0.0005）相关。在控制提供者性别、成员隶属关系、实践环境和从业年限后，阅读指南仍然是备孕患者教育的独立预测因素（p < 0.01）。
内分泌学会的《妊娠和产后甲状腺功能障碍管理指南》仅能接触到少数参与产科的医生，但接触该指南确实会影响患者的护理。多学科方法制定指南将提高指南的传播和实际应用。
