Department of Chemical and Process Engineering, University of Canterbury, Christchurch, New Zealand.
Endometriosis New Zealand, Christchurch, New Zealand.
Health Expect. 2024 Oct;27(5):e70015. doi: 10.1111/hex.70015.
There is a growing body of literature concerning endometriosis patients' perspectives on the healthcare system and endometriosis care in New Zealand. However, there is little research available on the perspectives of general practitioners (GPs) internationally, and none currently in New Zealand. The purpose of this study is to address New Zealand GPs' understanding of and approach to endometriosis diagnosis, referrals, management and guidelines.
An online, anonymous survey was shared with 869 GP clinics and completed by 185 New Zealand-based GPs regarding their awareness and application of the inaugural 2020 'Diagnosis and Management of Endometriosis in New Zealand' guidelines, their perception of their endometriosis knowledge, the diagnostic value they assign to symptoms, the treatments they recommend and the reasons they refer patients to specialist gynaecologists. Differences between groups were conducted using Chi-squared tests, and text answers were assessed thematically using inductive, semantic coding.
All 185 GPs had gynaecology consults, and 73% had gynaecology consults every week. Despite 65% being aware of the 2020 guidelines, only 35% overall had read them. Only 52% of GPs considered themselves to know enough about endometriosis for their routine practice. The most common treatment to be considered first line was intrauterine contraceptive devices (IUDs; 96%), whereas the most common alternative treatment recommended was exercise (69%). The most common reason for referral to specialist care was the failure of all attempted treatments (84%).
Many of the study's results align with current New Zealand and international endometriosis guidelines, particularly the prioritisation of progestin-only therapies, the reduced emphasis on surgical treatment as the first line and the low rates of alternative treatment recommendations. This study also highlights the need to improve awareness of inappropriate GP recommendations, including long-term treatment with prescription-only pain relief such as codeine and pregnancy for symptomatic relief.
Two of the authors involved in the design and conduct of the study, data interpretation and manuscript preparation have sought care for endometriosis.
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关于子宫内膜异位症患者对新西兰医疗保健系统和子宫内膜异位症护理的看法，已有越来越多的文献报道。然而，国际上关于全科医生（GP）的观点的研究很少，新西兰目前也没有。本研究旨在探讨新西兰全科医生对子宫内膜异位症诊断、转诊、管理和指南的理解和方法。
一项在线匿名调查被分发给 869 家 GP 诊所，有 185 名新西兰全科医生完成了调查，内容涉及他们对 2020 年首次发布的《新西兰子宫内膜异位症诊断和管理指南》的认识和应用、他们对子宫内膜异位症知识的感知、他们对症状的诊断价值、他们推荐的治疗方法以及他们将患者转诊给妇科专家的原因。使用卡方检验比较组间差异，采用归纳法、语义编码对文本答案进行主题评估。
所有 185 名全科医生都有妇科会诊，73%的医生每周都有妇科会诊。尽管 65%的医生了解 2020 年的指南，但只有 35%的医生阅读过该指南。只有 52%的全科医生认为自己对子宫内膜异位症的了解足以满足日常实践的需要。被认为是一线治疗方法的最常见方法是宫内节育器（IUD；96%），而推荐的最常见替代治疗方法是运动（69%）。最常见的转诊到专科护理的原因是所有尝试的治疗方法都失败了（84%）。
本研究的许多结果与新西兰和国际子宫内膜异位症指南一致，特别是孕激素治疗的优先地位、手术治疗作为一线治疗的重要性降低以及替代治疗方法的推荐率较低。本研究还强调需要提高对不适当的 GP 建议的认识，包括长期使用处方止痛药（如可待因）和妊娠作为缓解症状的方法。
参与研究设计和实施、数据解释和手稿准备的两位作者曾因子宫内膜异位症寻求过治疗。
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