Thresholds for surgical referral in primary hyperparathyroidism: A conjoint analysis

Area of Science:

• Endocrinology
• Surgical Referral Patterns
• Health Services Research

Background:

• Primary hyperparathyroidism (PHPT) is curable with surgery, but patient referral patterns are inconsistent.
• Referral decisions are often influenced by individual healthcare providers.
• Understanding these influences is key to improving surgical access for PHPT.

Purpose of the Study:

• To identify key factors influencing physician referral for surgical treatment of PHPT.
• To analyze the impact of clinical and biochemical parameters on surgical referral decisions.

Main Methods:

• A conjoint analysis study was conducted using an online survey.
• Physicians (endocrinologists and others) evaluated 10 patient scenarios.
• Referral decisions were based on clinical (age, comorbidities) and biochemical (mild vs. classic PHPT) factors.

Main Results:

• Referral for surgery was significantly higher for classic PHPT, patients under 50, those without comorbidities, and with osteoporosis (p < 0.001).
• Seeing a surgical provider also increased referral likelihood.
• Physician demographics (gender, experience, setting) did not significantly impact referral decisions.

Conclusions:

• Non-surgical physicians were less likely to refer older patients (age ≥ 50), those with comorbidities, or mild disease for surgery.
• Despite proven surgical benefits, access remains limited due to provider-dependent factors.
• Increased physician education and advocacy are crucial for enhancing surgical treatment access for PHPT.