Patient and professional Attitudes and perceptions of Thyroid control in General Practice (PATH-GP)
Poor thyroid control is defined as thyroid stimulating hormone (TSH) levels outside the reference range in a levothyroxine treated hypothyroid population. This cohort of patients have an increased risk of cardiovascular events, fractures, and are more likely to need repeated blood tests, have frequent levothyroxine dose adjustments, and cause prescription wastage from poor compliance. No studies to date have explored behavioural factors linked to TSH control in hypothyroid patients
This in-depth interview study with 40 participants in the North East and North Cumbria uses a grounded theory approach to explore the attitudes and perceptions to TSH control of hypothyroid individuals with thyroid hormone replacement therapy. Participants include 20 health care professionals involved in their management in a primary care setting (GPs, practice nurses and pharmacists) and 20 patients (N=10 with TSH levels outside the reference range and N=10 with TSH inside the reference range). As well as our own empirical enquiry we draw upon the Health Belief Model (HBM) of behaviour change to explore patient and professional perceptions of susceptibility and severity of disease as well as the barriers to, and benefits of, achieving good TSH control.
Thirteen patients have been interviewed, nine with TSH levels within reference range and four with TSH levels outside of the reference range. Seven out of nine well controlled patients were female (age range 36-85, average 61) and two male (aged 79 and 87). Two out of three poorly controlled patients were female (aged 38 and 68) and one male (aged 68). The full results (N=40 participants) will be presented at the conference.
Perception of disease severity, consequences related to poor compliance or simply being out of the therapeutic treatment range was lacking in both well and poorly TSH controlled patients. Many of the interviewees with good TSH felt ‘out of control’ and symptomatic, but their good TSH result presented a barrier to further discussion with their health professional.
Overall, patients’ attitude to their disease was good and evidenced by excellent adherence with only one patient intermittently forgetting to take her levothyroxine. Some interviewees felt that TSH estimation was too crude a measure to gauge ‘good control’, indeed the population reference range is broad and a rough guide for any one individual.
Early results indicate that thyroid control has a significant behavioural component. This is in addition to the known association with co-morbidities as well as drug interactions. Pharmacogenomic associations have yet to be quantified. Tailoring patient outcomes to a combination of quality of life measure, symptom scores as well as TSH/T4 estimation may give better patient outcomes, however, the cost-effectiveness should be considered. The results from this study will contribute to a greater understanding of the barriers and enablers of good thyroid control.