A Study of Thrombophilia Testing and Counseling Practices of Family Physicians Using the Script Concordance Method in Calgary, Canada.

Schneider-Macrae N, Jackson SC, Valentine KA, Lockyer J, Poon MC.

Abstract

Background: Thrombophilia testing helps to identify populations at risk of venous thromboembolism, but motivations for testing individuals are frequently unclear. Objectives: Our goals were to assess the motivations for thrombophilia testing among family physicians (FPs) to determine whether testing was congruent with expert opinion, and to study counseling practices. Methods: The FPs and experts completed a survey involving hypothetical thrombophilia patients. Responses between groups were compared using the script concordance method. Results: The FPs referred 35.9% of cases. Of the five scenarios, two resulted in disagreement regarding appropriateness of testing (P ≤ .037). The FPs were more likely to test male, obese, or pediatric patients, patients with a family history of myocardial infarction or infertility, and patients with a recent event (P ≤ .043). The FPs were more likely to counsel patients after testing (P ≤ .016). Conclusion: Disagreement exists between physician groups about the utility of thrombophilia testing. Self-reported lack of pretest counseling among FPs warrants further study.