Family Practice Vol. 19, No. 3, 247-250
© Oxford University Press 2002
Erectile dysfunction—the effect of sending a questionnaire to patients on consultations with their family doctor
Department of Family Medicine University of Tel Aviv, Israel.
S Vinker, MD, PO Box 14238, Ashdod 77042, Israel.
Kitai E, Vinker S, Kijner F and Lustman A. Erectile dysfunction—the effect of sending a questionnaire to patients on consultations with their family doctor. Family Practice 2002; 19: 247–250.
Received 30 March 2001; Revised 6 September 2001; Accepted 7 January 2002.
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Abstract |
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Background. Erectile dysfunction (ED) is a common problem among male adults that generally has been ignored by family practitioners.
Objective. Our aim was to assess the effect of a mailed questionnaire about ED on the readiness of patients to raise the subject with their family doctor.
Methods. The study population included all men aged 40 years and over on the patient list of a family practitioner. A control group made up of males of similar ages was chosen in another family practice. The patient files were reviewed for ED. Anonymous questionnaires including questions about sexual dysfunction and satisfaction with sex life, as well as demographic and medical details, were sent to the study population. Patients who suffered from ED were invited to visit their family doctor. In the following 2 months, the study and control group populations' visits to the family practitioner were monitored for complaints of sexual dysfunction.
Results. In the 2 years prior to the study, 14/205 (6.8%) of the study population had complained to their family practitioner of ED in comparison with 6/205 (2.9%) in the control group (P = NS). In the 2 months following the sending of the questionnaire, 23 patients consulted their family practitioner with ED, 19 of whom had not discussed their problem with the family practitioner previously; only a further two patients went to discuss ED in the same period in the control group (P < 0.001). A total of 85/205 (41.5%) patients returned the questionnaire and 35/85 (42.5%) said they suffered from ED. Of 35 patients who reported ED, 15 had been for a consultation; only six of them consulted their family doctor.
Conclusion. ED is reported infrequently to family doctors. Sending an anonymous questionnaire on the subject increases awareness of the problem and in turn increases the number of cases that can be treated.
Keywords. Erectile dysfunction, family practitioner, questionnaire.
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Introduction |
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Erectile dysfunction (ED) is a common problem amongst male adults, and its prevalence increases markedly with age; 34–52% of males report ED.1–6 At ages 40–49 years, the prevalence is ~3%, but increases to 64% in the 70–79 age group.4 Illnesses such as hypertension, ischaemic heart disease and especially diabetes are causes of the increasing prevalence of ED in the elderly.
The treatment of ED generally has been ignored by family practitioners.1 Possible explanations include: family practitioners being unaware of the true prevalence of the problem, the sensitivity of raising the problem, outdated knowledge, lack of time and lack of training of family practitioners to discuss the subject with their patients.1,7
ED that is not diagnosed and treated correctly can be a cause of morbidity including low self-esteem, depression, anxiety, somatic complaints and a reduced quality of life.7–10 An increased awareness amongst doctors and legitimizing visits to family practitioners to treat the problem could have a positive effect.
Anonymous questionnaires, sent to patients by the family doctor, dealing with sensitive issues such as sexual dysfunction could lower the barriers that many patients perceive and allow more open discussion of the subject. Read et al.3 found that sending a questionnaire to patients about their sex life increased the number of diagnoses of sexual dysfunction from 2 to 35% of men and 42% of women. Shahar et al.11 found that 31–63% of those who answered an anonymous questionnaire were not satisfied with their sex lives. In these studies, there was a low response rate to the questionnaires.4,12 To the best of our knowledge, the effects of a written questionnaire on consultations with family practitioners have not been investigated.
The aim of our study was to see how a questionnaire on ED sent by a family practitioner to his patients could affect the readiness of patients to raise the subject with their doctor.
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Methods |
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The study population included all men aged over 40 years old (205 patients) who were on the patient list of one of the authors (EK)—a family practitioner working in an HMO primary care practice group practice.
Two doctors reviewed the computerized files of the target population from 7 July 1997 (the date computerized files were introduced) until 6 June 1999 for any mention of ED, whether as the presenting complaint or as a problem discussed during a visit to the family practitioner. Anonymous questionnaires were then sent out to the homes of the study population. The questionnaire included demographic details, questions on hypertension, diabetes, urological problems, past surgery and medications. The patients were asked if they suffered from sexual dysfunction, and to quantify the dysfunction subjectively (severe, moderate, not at all). The patients were also asked if they were satisfied with their sex life. Those patients that said they suffered from sexual dysfunction were asked to whom they had turned for advice and treatment, and which treatment they preferred. At the end of the questionnaire, the patients who suffered from ED were invited to visit their family doctor for investigation and treatment of the problem. The patients were asked to return the questionnaire, anonymously, using a stamped addressed envelope that was attached. About 2 weeks after the questionnaires were sent, a telephone call was made to all the patients to check that they had received the questionnaire and to remind them to return it as soon as possible.
In the 2 months following the sending of the questionnaires, the study populations' visits to the family practitioner were monitored to see if they complained of sexual dysfunction. The family practitioner was instructed not to take a structured sexual history, as well as not to ask on his own initiative specific questions on sexual functioning
A control group, made up of 205 males of similar ages and from a similar socio-demographic background, was chosen in another family practice. The medical files were retrieved in the same way. The family practitioner of the control group was unaware of the study.
Both physicians were board certificated family physicians, involved in teaching and other academic activities in family medicine. The two physicians have participated in a CME course of the Israeli Family Medicine Association for the management of ED, especially dealing with ways to cope with hidden ED. They were male physicians in their forties, married with children. They had worked in the study clinics for ~4 years.
The variables were entered into the SPSS software and a statistical analysis performed using Student's t-test and chi-square test.
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Results |
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On reviewing the files of the 2 years prior to the intervention, 14/205 (6.8%) patients were found to have complained to their family practitioner of ED. In the 2 months following the sending of the questionnaire, 23 patients consulted their family practitioner with ED, 19/205 (9.3%) of whom had not discussed their problem with the family practitioner previously. In the control group, 6/205 (2.9%) of patients were known to have ED; only a further two patients (1%) went to discuss ED in the 2 months of the study (Table 1
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A total of 85/205 patients returned the questionnaire; a response rate of 41.5%. Thirty-six (42.5%) of the responders said they suffered from ED. Table 2
compares the characteristics of the patients who reported suffering from ED with those who did not have the problem. A clear association was found between ED and satisfaction with sex life. Of 36 patients who reported ED, 15 (42%) had been for a consultation, mainly to urologists (10 patients) or to the family doctor (six patients). Twenty-one patients (58%) who reported ED had not been for any type of consultation. Six felt that the problem had no relevance, three felt embarrassed, two thought it was normal at their age and one did not believe treatment worked. Most of those who reported ED said they preferred treatment with tablets (83%). Only three preferred to be treated with injections into the penis.
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Discussion |
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The response rate to the questionnaire was 41.5%. In other studies which investigated ED using questionnaires, similar low response rates were found.4,12 However, the main aim of our study was to see if a mailed questionnaire as an intervention per se could increase patients' visits to the family doctor regarding problems of ED, and therefore the relatively low response rate probably does not have relevance to the study results.
The sex and personality of the family practitioner have been shown to be of importance for the patients' willingness to offer information on sexual symptoms or discuss such concerns with their family practitioner.13,14 The professional and personal characteristics of the study and control physicians were similar, limiting the bias caused by these factors on patients' willingness to report sexual dysfunction. The main finding of the study is that a questionnaire sent to patients on ED encourages those suffering from the problem, and who have not yet been to their doctor, to consult their family physician. The doctor participating in the study was instructed not to initiate the ED issue, as it is known that the effect of taking a sexual history on the number of sexual dysfunction diagnoses made is substantial.15 The new cases were found as a consequence of the patients raising the issue during the consultation. We found that the number of new consultations following the questionnaire was greater than all the consultations on the subject over the previous 2 years. Furthermore, in the control group, no such increase was seen. This fact cancels out any effect that the introduction and publicity surrounding sidenafil may have had on encouraging patients to go to their doctors for consultations about ED. It is still possible that the doctor participating in the study had a greater awareness of the subject and that the increase in reporting of ED is not due solely to the questionnaire.
Our findings, together with previous studies, may indicate that sending questionnaires to patients can have a positive effect in raising awareness of the existence of sensitive medical problems. It appears that this could be a valuable method to raise other sensitive subjects such as urinary incontinence. The letter introduces the subject to the patient, and allows him to overcome the tendency to avoid dealing with such a sensitive problem, without any immediate personal contact with the doctor.
Most of the patients suffering from ED who had been for a consultation had consulted directly with a urologist. Most patients also expressed a clear preference for treatments using tablets. The most common treatment today for ED is sidenafil, which has shown clear success in treatment compared with placebo.16,17 The main contraindication for treatment with sidenafil is the use of nitrates, due to the potentiation caused by concomitant use of these two drugs. Sidenafil can be prescribed by family practitioners in Israel, as in many countries. It is possible that patients who consult urologists directly think family practitioners cannot treat their problem. Information on the subject sent to the patients by their doctor can change this attitude, particularly as family practitioners are readily available, and usually know both parties, allowing a more comprehensive treatment.
In summary, ED is very common, but is reported infrequently to family doctors. Sending an anonymous questionnaire on the subject increases awareness of the problem and in turn increases the number of cases that can be treated, thus improving the patient's quality of life.
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References |
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3
Read S, King M, Watson J. Sexual dysfunction in primary medical care: prevalence, characteristics and detection by the general practitioner. J Public Health Med 1997; 19: 387–391.
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Shahar E, Lederer J, Herz MJ. The use of a self-report questionnaire to assess the frequency of sexual dysfunction in family practice clinics. Fam Pract 1991; 8: 206–212.
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17
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