The Role of Clinical Guidelines in Patient Care: Thyroid Hormone Replacement in Women of Reproductive Age

Abstract

Clinical guidelines have a role in medical education and in the standardization of patient care. However, it is not clear whether guidelines created by subspecialists reach relevant practicing physicians or influence patient care. In 2007 the Endocrine Society released "Guidelines on the Management of Thyroid Dysfunction During Pregnancy and Postpartum." The objective of this study was to characterize the role of these guidelines in provider education and in subsequent patient care decisions. In 2009 three waves of mail surveys were distributed to 1601 Wisconsin health care providers with a history of providing obstetric care. Survey participants were members of the American College of Obstetricians and Gynecologists or the American Academy of Family Physicians. There were 881 returned surveys (55%) and 575 were eligible for the study (adjusted rate 52.5%). Although only 11.5% of providers read the Endocrine Society's guidelines, reading the guidelines was associated with increased likelihood of prepregnancy counseling on levothyroxine management (p < 0.0001), increased likelihood of screening for thyroid disease risk factors (p = 0.0007), and increased likelihood of empiric levothyroxine dose increase in pregnant patients (p = 0.0005). After controlling for provider sex, membership affiliation, practice setting, and number of years in practice, reading the guidelines was still an independent predictor of patient education prepregnancy (p < 0.01). The Endocrine Society's "Guidelines on the Management of Thyroid Dysfunction During Pregnancy and Postpartum" reached a minority of providers involved in obstetrics, but exposure to the guidelines did impact patient care. A multidisciplinary approach to guideline creation would improve the dissemination and practical application of guidelines.