. 2020 Apr 28;9(5):445–456. doi: 10.1530/EC-20-0129
This work is licensed under a Table 5.
Reported trends in physicians’ practices regarding management of adrenal insufficiency patient and some challenges/barriers to optimal care.
| SSAc (n = 1474) | MENAc (n = 828) | P-valued | Total (%, 95% CI) | P-valuee | |
|---|---|---|---|---|---|
| Patterns of glucocorticoid replacement | |||||
| Therapeutic drugs used | |||||
| Hydrocortisone | 588 (39.9) | 780 (94.2) | <0.001 | 1368 (59.4, 57.4–61.4) | Reference |
| Fludrocortisone | 368 (25.0) | 460 (55.6) | <0.001 | 828 (36.0, 34.0–38.0) | <0.001 |
| Cortisone acetate | 139 (9.4) | 29 (3.5) | <0.001 | 168 (7.3, 6.3–8.4) | <0.001 |
| Prednisone | 442 (30.0) | 105 (12.7) | <0.001 | 547 (23.8, 22.0–25.6) | <0.001 |
| Dexamethasone | 129 (8.8) | 51 (6.2) | 0.026 | 180 (7.8, 6.8–9.0) | <0.001 |
| Betamethasone | 40 (2.7) | - | - | 40 (1.7, 1.2–2.5) | <0.001 |
| Method used in drug dose adjustment | |||||
| Adjusted for body weight | 141 (60.8) | 22 (43.1) | 0.0.021 | 163 (57.6, 51.6–63.4) | Reference |
| Adjusted for body surface area | 22 (9.4) | 7 (13.7) | 0.349 | 29 (10.2, 7.0–14.4) | <0.001 |
| Fixed dose for all patients | 72 (31.0) | 22 (43.1) | 0.097 | 94 (33.2, 27.8–39.0) | <0.001 |
| Reported drug non-availabilitya,b | |||||
| All medicine | |||||
| Never unavailable | 111 (47.8) | 30 (66.7) | 0.049 | 141 (50.9, 44.8–56.9) | 0.172 |
| Sometimes/often unavailable | 110 (47.4) | 15 (33.3) | 125 (45.1, 39.2–51.2) | ||
| Hydrocortisone | |||||
| Never unavailable | 150 (64.4) | 26 (56.5) | 0.118 | 176 (63.1, 57.1–68.8) | <0.001 |
| Sometimes/often unavailable | 72 (30.9) | 20 (43.5) | 92 (33.0, 27.5–38.8) | ||
| Fludrocortisone | |||||
| Never unavailable | 62 (26.5) | 20 (42.6) | 0.008 | 82 (29.2, 23.9–34.9) | <0.001 |
| Sometimes/often unavailable | 148 (63.2) | 27 (57.4) | 175 (62.2, 56.3–68.0) | <0.001c | |
| Prednisone | |||||
| Never unavailable | 186 (81.2) | 37 (82.2) | 0.798 | 223 (81.4, 76.3–85.8) | <0.001 |
| Sometimes/often unavailable | 31 (13.5) | 7 (15.6) | 38 (13.8, 10.0–18.5) | <0.001c | |
| Dexamethasone | |||||
| Never unavailable | 127 (55.0) | 31 (70.4) | 0.121 | 158 (57.4, 51.4–63.4) | <0.001 |
| Sometimes/often unavailable | 89 (39.5) | 10 (22.7) | 99 (36.0, 30.3–42.0) | 0.458c | |
| Betamethasone | |||||
| Never unavailable | 99 (42.9) | 28 (65.1) | 0.017 | 127 (46.4, 40.3–52.4) | 0.080 |
| Sometimes/often unavailable | 98 (42.4) | 9 (20.9) | 107 (39.0, 33.2–45.1) | 0.142c | |
| Additional barriers to managementa | |||||
| Method of patient identification | |||||
| None | 1233 (83.6) | 330 (40.4) | <0.001 | 1563 (67.9, 65.9–69.8) | Reference |
| Bracelet | 152 (10.3) | 56 (6.8) | 0.004 | 208 (9.0, 7.9–10.3) | <0.001 |
| Card | 89 (6.0) | 442 (53.4) | <0.001 | 531 (23.1, 21.4–24.8) | <0.001 |
| Communication-type barriers to managementa | |||||
| Educational level | 110 (48) | 28 (64) | 0.161 | 138 (50.5, 44.4–56.6) | Reference |
| Language issues | 79 (34) | 8 (17) | 0.010 | 87 (31.1, 25.8–37.0) | <0.001 |
| Cultural issues | 91 (40) | 17 (37) | 0.154 | 108 (39.5, 33.7–45.6) | 0.010 |
aPercentages according to respondent doctors (n = 276 for SSA and 56 for MENA); bPercentages calculated out of total responses given including ‘not sure’ responses; cResported responses as Number (%); dP-value1: comparison of management strategies in SSA and MENA; eP-value2: comparison of all patients’ management strategies.
MENA, Middle East and North Africa; SSA, Sub-Saharan Africa.