Page 57 - Diagnostic delay of endometriosis

questions concerning clinical insight, e.g., symptoms and treatment options. The GPs scored on average 4.0 points (40%) on factual knowledge and 8.9 points (49.4%) on clinical insight. The male GPs worked on average more hours a week (0.84 versus 0.63 full time equivalent; P < 0.01) and had more years of working experience (18.8 versus 11.7; P 0.04) compared with the female GPs. No significant differences were found in mean score (male 11.7 versus female 12.0) or number of correctly answered questions (male 16.6 versus female 16.6) between sexes. No correlation was found between the knowledge scores and number of patients with suspected endometriosis per year, or with patient exposition (weekly working hours and years of experience). Seventy six out of 87 GPs stated that they felt a need for education (14 GPs did not answer this question).
Discussion
This is the first study to explore the knowledge and diagnostic and clinical strategies of GPs to diagnose and treat endometriosis in The Netherlands. The results of the questionnaire help to clarify factors influencing diagnostic and treatment delay. It represents the opinion of GPs, in contrast to many other studies, which often have the patient or gynaecologist as information source. In our opinion, the information gathered in this study can help to formulate strategies to increase awareness of endometriosis among first line medical professionals, to develop kills to reduce diagnostic delay and ultimately to improve management of women affected by endometriosis. The GPs in our study estimate the total diagnostic delay at 65.7 months or 5.5 years: 39.1 months from start of symptoms to first presentation and 26.6 months from first presentation to diagnosis. According to previous studies, the diagnostic delay in other European countries varies from 4 to 10 years.6,8,9
These numbers are difficult to compare because of differences in healthcare organizations and funding between countries, factors proven to influence time to diagnosis.9 Also, most studies use data obtained from the patient rather than from the GP. A patient based study in the same region we have undertaken showed a total diagnostic delay of 89 months, most of which reflected GP delay.11 The difference in GP delay between the patient and GP-based questionnaire is 31.6%; however, these numbers are still within the lower range compared with other European countries. The high rate of referral for diagnostic tests or consultation in our study group (in total 56.7%) may indicate the GPs feel an urge for specialist confirmation of the diagnosis
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