Page 82 - Diagnostic delay of endometriosis

were discussed with several members of the research team. The variety of the research team is one of the strengths of this study. Moreover, we selected participants with different levels of experience to obtain a complete set of barriers and facilitators. The setting of focus groups with all colleagues from a group practice reduced the likelihood of including only participants with a special interest in the matter and therefore underreporting of barriers in daily practice. Although less than 0.5% of GPs in the Netherlands completed a specialty training in women’s health, we intended to include group practices with a contracted specialized GP to make sure different levels of experience and exposure were represented in the study population.
Some limitations of this study should be discussed. Selection bias may have occurred because of the sampling procedure. However, the involvement of all GPs from the participating group practices, the geographical spread and the variety in level of experience increases the generalizability of our findings. Nevertheless, countries with a different health care setting may bring about other barriers and facilitators to a timely diagnosis of endometriosis. Furthermore, the determinants identified in this study may not be comprehensive, and future research activities directed at the diagnostic process can complement our findings.
To date, studies reflecting the GPs’ perspective on endometriosis care are scarce. There are some retrospective studies about the diagnostic process in general practice based on primary care records reporting similar findings with regard to the role of the GP in the diagnostic delay of endometriosis. One study extracted information from primary care records in the UK demonstrating that repeated consultations and negative diagnostic tests contributed to a median delay of 9.0 years between first consultation and diagnosis 17. Another British study identified a predictive value of linking features of consecutive consultations over time to a subsequent diagnosis of endometriosis 18. This finding may help in the development of diagnostic support systems in general practice. Prevalence rates concerning endometriosis differ according to the type of study population, with higher estimated prevalence rates seen in clinical studies as compared to community-based or database estimates 1,3,18-21. Although population- based studies may appear to reflect the actual prevalence rate in general practice, they are likely to be hampered by incomplete coding in medical records or databases and missed diagnosis in symptomatic women. It is important for GPs to be aware of the possibility of an underlying condition like endometriosis in consultations concerning abdominal pain, dysmenorrhoea or other symptoms related to
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