1 Division of Endocrinology Georgetown University, Washington, DC.
2 Department of Biostatistics and Biomedical Informatics, MedStar Health Research Institute, Washington, DC.
Thyroid. 2019 Jan;29(1):44-52. doi: 10.1089/thy.2018.0369. Epub 2018 Dec 17.
Physician characteristics and perceptions and their effect on choice of therapies for patients with thyroid cancer have been well studied. Some data also exist about physician characteristics and prescribing treatment for subclinical hypothyroidism. The effect of physician characteristics on prescribing thyroid preparations for treating overt hypothyroidism is less studied.
Members of the American Thyroid Association were surveyed in 2017. Physicians were presented with 13 different theoretical patients with hypothyroidism and asked to choose among six therapeutic options, including levothyroxine, synthetic combination therapy, thyroid extract, and liothyronine monotherapy. The 13 patient scenarios incorporated parameters that potentially provide reasons for considering combination therapy (presence of symptoms, low serum triiodothyronine concentration, and documentation of deiodinase polymorphisms). Repeated-measures logistic regression analysis was performed to examine the prescribing of the various therapies. Data regarding the responding physicians were also collected. These data included number of years in practice, country of practice, and specialty. Multivariate repeated-measures logistic regression analysis of prescribing patterns was also conducted controlling for all patient and physician characteristics.
Of the 389 survey respondents, 93% prescribed therapy for hypothyroidism. Fifty-three percent of respondents had been in practice for >20 years, and 23% had been in practice for 11-20 years. Sixty-four percent practiced in North America, and 18% practiced in Europe. Eight-six percent were endocrinologists, and 5% were surgeons. In multivariate analysis, physicians from North America were both more likely to prescribe any triiodothyronine-containing therapies (odds ratio [OR] = 1.8 [confidence interval (CI) 1.3-2.4]) and more likely to add liothyronine to levothyroxine therapy (OR = 1.9 [CI 1.2-2.9]). In addition, they were more likely to prescribe desiccated thyroid extract or liothyronine monotherapy (OR = 1.7 [CI 1.0-2.9]).
A previous analysis of this survey showed that patient characteristics profoundly affect physician prescribing patterns. The current multivariate analysis shows that physician characteristics affect prescribing patterns. Whether this is due to impact upon physicians of patient-related experiences, media exposure, influence from pharmaceutical companies, educational activities, or other concerns cannot be determined. However, these results have potential importance for understanding physician-patient interactions at a time when the benefits and risks of triiodothyronine-containing therapies have not been fully documented.
医生的特征和观念及其对甲状腺癌患者治疗选择的影响已得到充分研究。关于医生的特征和治疗亚临床甲状腺功能减退症的处方数据也存在一些。关于医生特征对治疗显性甲状腺功能减退症的甲状腺制剂处方的影响的研究较少。
2017 年对美国甲状腺协会的成员进行了调查。向医生提供了 13 名不同的甲状腺功能减退症理论患者，并要求他们在 6 种治疗选择中进行选择，包括左旋甲状腺素、合成联合治疗、甲状腺提取物和左甲状腺素单药治疗。这 13 个患者场景纳入了可能考虑联合治疗的参数（存在症状、血清三碘甲状腺原氨酸浓度低和脱碘酶多态性的记录）。使用重复测量逻辑回归分析来检查各种治疗方法的处方。还收集了关于回复医生的数据。这些数据包括行医年限、行医国家和专业。还对所有患者和医生特征进行了控制，对处方模式进行了多变量重复测量逻辑回归分析。
在 389 名调查参与者中，93%的人开了治疗甲状腺功能减退症的处方。53%的受访者行医时间超过 20 年，23%的人行医时间为 11-20 年。64%的人在北美行医，18%的人在欧洲行医。86%是内分泌学家，5%是外科医生。在多变量分析中，来自北美的医生更有可能开出任何含有三碘甲状腺原氨酸的治疗药物（比值比[OR] = 1.8 [置信区间（CI）1.3-2.4]），也更有可能在左旋甲状腺素治疗中添加左甲状腺素（OR = 1.9 [CI 1.2-2.9]）。此外，他们更有可能开出干燥甲状腺提取物或左甲状腺素单药治疗（OR = 1.7 [CI 1.0-2.9]）。
对该调查的先前分析表明，患者特征极大地影响了医生的处方模式。当前的多变量分析表明，医生的特征会影响处方模式。这是否是由于患者相关经验、媒体报道、制药公司的影响、教育活动或其他问题对医生的影响，尚无法确定。然而，在尚未充分记录三碘甲状腺原氨酸治疗的益处和风险的情况下，这些结果对于理解医患互动具有潜在的重要性。
