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DOI: 10.1055/s-0035-1547616
Endocrinologists' opinions on the quality of health care in patients with endocrine disorders: Objective, design and and first results of the german dialogue project “Selecting Wisely” involving general practicioners and endocrinologists
Background: The US Choosing Wisely initiative addresses problems of health care delivery in various specialties by publishing recommendations for patients and physicians. The German dialogue project “Selecting Wisely” focusses on over-, under or misuse of diagnostics and therapy in patients with endocrinopathies. Aiming to develop better care, the initiative integrates the perspectives of endocrinologists and general practitioners.
Methods: A questionnaire based survey was performed among endocrinologists and general practitioners in Germany each with large ambulatory practices, addressing 46 endocrine disorders. Here we present the answers given by the 5 endocrinologists.
Results: A total of 389 comments were provided and the following disease groups were addressed: 1. thyroid disorders, 2. pituitary disorders, 3. osteoporosis, 4. adrenal failure, 5. hypogonadism and 6. abnormal menstrual cycle. Concerning Hashimoto's thyroiditis a general over-use in diagnostics and therapy was addressed, in Graves' disease, goitre and thyroid nodules an overuse of nuclear medicine imaging was noted. An under-use of diagnostic ultrasound and fine needle biopsies paralleled by an unnecessary high percentage of operations was pointed out for thyroid nodules. Delayed diagnosis and insufficient medication was mentioned for acromegaly, pituitary and adrenal insufficiency. For osteoporosis, lack of screening of risk groups, over-use of bone densitometry and inadequate or delayed therapy was highlighted. The need to optimize differential diagnosis and medication regimen was noted for hypogonadism. Hormonal replacement for patients with menstrual irregularities was considered as frequent therapeutic over- and misuse.
Perspective: As a next step, we will compare these results with the opinions provided by the general practitioners. Based on this comparison we aim to establish an interdisciplinary dialogue to improve health care pathways for patients with endocrine disorders in Germany