BTA members say there is a significant health professional behavioural component to the management ofh ypothyroidism.

[holyshedballs]

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

bmjopen.bmj.com/content/8/2...

Abstract

Objective To explore the attitudes and perceptions of health professionals towards management of hypothyroidism that contributes to the suboptimal treatment of hypothyroidism in general practice.

Design

A qualitative interview study using semistructured interviews.

Participants

Sixteen participants were interviewed between March and August 2016 comprising nine general practitioners (GPs), four pharmacists, two practice nurses and one nurse practitioner.

Setting

General practice and community pharmacies in the counties of Northumberland, Tyne and Wear, Stocktonon-Tees and North Cumbria, North of England, UK.

Method

A 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.

Results

Although 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.

Conclusion

There 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.

[helvella Administrator]

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.

Even when they are being asked to consider how they handle hypothyroid patients, they end up blaming the patients!

Sure, we see too many patients who have not "been compliant". But how many of those patients have had the importance of their treatment properly explained?

Nonetheless, it is good that some people are asking these questions.

[holyshedballs in reply to helvella]

That’s what they think but the other study I posted today says patients ARE generally compliant.

It seems that GPs are quick to blame insufficient thyroid medication on the patient not taking it rather than the health professionals not prescribing enough in the first place.

It highlights a big knowledge gap in primary care.

But what is taught to “refresh” their knowledge is mostly dependent on the BTA and the draft NICE guidelines.

[m7-cola in reply to holyshedballs]

Most doctors and ‘medical professionals ‘ seem decades out of date in their knowledge of thyroid issues.

[MissGrace]

‘Although health professionals felt that hypothyroidism was easy to manage...’

Says it all really. And just as easy to totally mismanage.

Hanlon's razor: "Never attribute to malice that which is adequately explained by stupidity."

🤸🏿‍♀️🥛

[m7-cola in reply to MissGrace]

This hits the nail on the head!

[holyshedballs]

I could not agree more

I hope we all do it

[Breena in reply to holyshedballs]

I intend to do just that.

My husband asked his dr how long in training they spent on thyroid issues .answer about one hr.job done.

[loueldhen]

The BTA (and the ATA and the ETA) need to update their guidelines - I understand it's a monumentally boring task and I still fear it is too soon because they are at such an early stage of their 'awakening' and many are still in denial. The least the BTA could do would be to reissue their 2015 guidelines with their December 2016 liothyronine statement incorporated instead of it being conveniently forgotten and treated like a postscript. I have some hope for the NICE guidelines currently being worked on as at least they have some patient involvement.

[Hidden]

I have read the paper and feel sad, sad, sad. What a shambles and not just in the UK.

I actually live in the North East but thankfully self medicate.

[IanCSOHS]

We asked our GP to arrange bloods tests for T4 and T3 as my wife has the symptoms of hypothyroidism although her TSH reading was in range albeit at the lower end and so has what I understand to be subclinical hypothyroidism. The results sent by GP in a letter declare T4 and T3 to be within range. However when we use digital access to the bloods test results only T4 is showing and NOT T3. So I have emailed the GP to ask why there is no T3 result? Some practitioners will be a aware that NHS England have stopped GPs from prescribing liothyronine (raises T3) to new patients due to excessive cost inUK of £9 per pill which can only be prescribed by consultants. I can see us self medicating if we fail to get cooperation from GP to refer my wife to an endocrinologist who will be able to prescribe liothyronine with the cost will of drug being allocated to our GP's practice. GP letter does raise issues of avoidance maybe - I will keep you posted on his answer as to why T3 reading not showing!!