Attitudes and perceptions of health professionals towards management of hypothyroidism in general practice: a qualitative interview study

Abstract

ObjectiveTo explore the attitudes and perceptions of health professionals towards management of hypothyroidism that contributes to the suboptimal treatment of hypothyroidism in general practice.DesignA qualitative interview study using semistructured interviews.ParticipantsSixteen participants were interviewed between March and August 2016 comprising nine general practitioners (GPs), four pharmacists, two practice nurses and one nurse practitioner.SettingGeneral practice and community pharmacies in the counties of Northumberland, Tyne and Wear, Stockton-on-Tees and North Cumbria, North of England, UK.MethodA grounded-theory approach was used to generate themes from interviews, which were underpinned by the theory of planned behaviour to give explanation to the data.ResultsAlthough health professionals felt that hypothyroidism was easy to manage, GPs and nurses generally revealed inadequate knowledge of medication interactions and levothyroxine pharmacokinetics. Pharmacists felt limited in the advice that they provide to patients due to lack of access to patient records. Most GPs and nurses followed local guidelines, and relied on blood tests over clinical symptoms to adjust levothyroxine dose. The information exchanged between professional and patient was usually restricted by time and often centred on symptoms rather than patient education. Health professionals felt that incorrect levothyroxine adherence was the main reason behind suboptimal treatment, although other factors such as comorbidity and concomitant medication were mentioned. Enablers perceived by health professionals to improve the management of hypothyroidism included continuity of care, blood test reminders, system alerts for interfering medications and prescription renewal, and accessible blood tests and levothyroxine prescriptions for patients.ConclusionThere is a significant health professional behavioural component to the management of hypothyroidism. Addressing the differences in patient and professional knowledge and perceptions could reduce the barriers to optimal treatment, while continuity of care and increased involvement of pharmacists and practice nurses would help to promote optimal thyroid replacement.

Combination Thyroid Hormone Replacement; Knowns and Unknowns

“…Using TSH alone to make management decisions may not be effective for at least a sub-group of patients (7). All these factors result in challenging decisions and different priorities for patients and their physicians (88, 89).…”

Knowledge and Attitude of Doctors in Primary Care Settings Towards Thyroid Disorders: An Interventional Study

“…The management of Hypothyroidism is generally carried out in primary care, it's a simple condition to be managed and levothyroxine is well tolerated by most patients. Up to 2014 GPs were required to maintain a register of hypothyroid patients as apart of Quality Outcome Framework (QOF) [19], the same opinion was recorded by American Thyroid Association in 2013 reporting that many people with hypothyroidism can be treated effectively by their primary care doctor. The patient might need to see an endocrinologist for a second opinion or for regular care if he/she have one of these problems: (congenital hypothyroidism, pregnant, autoimmune hypothyroidism combined with one or more other autoimmune conditions, as type 1 diabetes, Addison's disease, or premature ovarian failure, epilepsy, heart disease, or bowel disease that affects the treatment of hypothyroidism or there is a trouble establishing the right dose of thyroxine) [20].…”

“…Attitude questions: Q (4,8,9,10,11,12,13,14,17,19) (open ended except 4, 17, 19 are closed ended questions) Q4, 8, 9, 10: According to U.S. Preventive Services Task Force Recommendation Statement [12] Q4: Do you order screening tests for thyroid dysfunction in nonpregnant asymptomatic adults? The right response is: no that is not recommend.…”

Inequitable Long-Term Outcomes for an Indigenous Population After Definitive Treatment of Patients With Graves Disease

“…If practice in our region of dosing inaction parallels that seen in this study from the United Kingdom, it is important to note that Māori, as an ethnic minority, are more severely affected by this undertreatment. A small British qualitative interview study of only 16 participants (including general practitioners, pharmacists, practice nurses, and a nurse practitioner) reported inadequate knowledge of levothyroxine medication interactions and pharmacokinetics by prescribers, and lack of time was identified as a barrier to improving thyroid management [18]. Although we would expect that standard practice would be to alter dosage and to recheck levels after ∼6 to 8 weeks ( i.e.…”