title: Management of Primary Hyperparathyroidism: Can We Do Better?
abstract: The failure to follow national guidelines in management of various diseases has been previously established. We sought to quantify primary care providers' familiarity with primary hyperparathyroidism as it affects adherence to the 2009 National Institute of Health (NIH) consensus recommendations in treatment of primary hyperparathyroidism. A large primary care group was surveyed to determine their familiarity with the 2009 NIH consensus recommendations for management of primary hyperparathyroidism (PHPT). Retrospective review of the group's records (2009-2011) was performed to verify compliance. Survey responders included 109 clinicians, 31 per cent were familiar with all criteria for surgical intervention in asymptomatic patients and 34 per cent correctly identified appropriate surveillance testing for patients undergoing observation. Chart review identified 124 patients with PHPT. Of the patients who met NIH criteria, 34 per cent had a parathyroidectomy. Younger age, higher intact parathyroid hormone, hypercalciuria, and history of nephrolithiasis were associated with surgery in multivariable analysis. Of the observed patients, 16 per cent had appropriate surveillance studies. In conclusion, this study confirms suboptimal adherence with consensus recommendations in management of PHPT. A minority of clinicians demonstrated solid familiarity with management strategies, paralleling their treatment approach. Educational efforts may improve adherence with upcoming national recommendations.
authors.affiliation: The Oregon Clinic, Portland, Oregon, USA.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Sharata
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Kelly
authors.forename: Yelena
authors.initials: Y
authors.lastname: Rozenfeld
authors.forename: Chet W
authors.initials: CW
authors.lastname: Hammill
authors.forename: Earl
authors.initials: E
authors.lastname: Schuman
authors.forename: James R
authors.initials: JR
authors.lastname: Carlisle
authors.forename: Shaghayegh
authors.initials: S
authors.lastname: Aliabadi-Wahle
mesh_terms: D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D058070:Asymptomatic Diseases / Q000628:therapy; D032921:Consensus; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D053565:Hypercalciuria / Q000150:complications; D049950:Hyperparathyroidism, Primary / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D007388:Internal Medicine / Q000706:statistics & numerical data; D008297:Male; D009316:National Institutes of Health (U.S.); D053040:Nephrolithiasis / Q000150:complications; D009922:Oregon; D016105:Parathyroidectomy / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000592:standards; D012189:Retrospective Studies; D014481:United States; D057832:Watchful Waiting