SAT234 Variations In Clinical Practice Patterns For Hypoparathyroidism

Abstract

Abstract Disclosure: K.L. Deering: None. Q. Harshaw: None. D.M. Mitchell: None. N.J. Larsen: None. B. Weiss: None. P. Loustau: None. S. Allas: None. Objectives: Emerging evidence regarding optimal treatment for patients with chronic hypoparathyroidism (cHP) has led to the development of updated evaluation and management guidelines. The goal of this study was to determine how current practice patterns for individuals with cHP compare with these guidelines. Methods: We extracted data from a large US claims database (130 million patients) from Oct 2014 to Dec 2019. cHP was defined as an HP diagnosis claim ≥6 months following neck surgery or ≥2 claims ≥6 months apart. Patient data were extracted from 1 year prior to surgery (if applicable) and up to 2 years following their qualifying HP claim. Additionally, a panel comprised of 103 endocrinologists and nephrologists (US=40, UK=21, France=21, Germany=21) was assembled and conducted chart reviews with each participant contributing data for 5 patients with cHP in their practice. Results: 5,302 patients met criteria for cHP from the claims database, while the physician panel chart review included 515 cHP patients. In the claims database, 33.0% saw an endocrinologist and 9.4% or less saw a nephrologist during the 1-year follow-up. Panel physicians reported being the decision maker for 93% of their cHP patients and 90% of the patients were seen at least twice per year. Guidelines recommend all new and established cHP patients be monitored for key laboratory values every 3-12 months. Overall, while neither study found monitoring practices consistent with guidelines, there was less laboratory monitoring in the database study than in the physician panel: serum magnesium (36.6%; 57%), serum phosphorous (36.8%; 90%), urine calcium (10.0%; 57%), and renal imaging (20.9%; 34%). Additionally, patients were monitored for bone health in the database study and physician panel (bone mineral density: 10.7%; 44%; bone markers: 5.2%; 25%). Conclusion: Real-world practice patterns vary from guideline recommendations; however, the practice patterns from the physician panel study align more closely with recommendations than the claims database study. This discrepancy may be due to patients less frequently utilizing physicians specialized in cHP in the database study. Our data underscore challenges with optimizing care for patients with this rare disorder. In addition, they suggest that ongoing efforts to educate both patients and physicians about management guidelines may improve care and ultimately enhance health and quality of life in cHP. Presentation: Saturday, June 17, 2023