Attitudes and perceptions of health professionals towards management of hypothyroidism in general practice: a qualitative interview study
Open accessAbstract
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, Stockton-on-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.
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GPs and nurses often have inadequate knowledge of medication interactions and LT4 pharmacokinetics; information exchange is usually restricted by time and often centered on symptoms rather than patient education.
“GPs and nurses often have inadequate knowledge of medication interactions and LT4 pharmacokinetics; information exchange is usually restricted by time and often centered on symptoms rather than patient education [63].”
From T4+T3 Combination Therapy: An Unsolved Problem of Increasing Magnitude and Complexity (2021) · cites this paper as [63]
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- Authors
- Dew, R., King, K., Okosieme, O. E., Pearce, S. H., Donovan, G., Taylor, P. N., Hickey, J., Dayan, C. M., Leese, G., Razvi, S., & Wilkes, S.
- Affiliations
- University of Sunderland (GB)
- Endocrinology and Diabetes Department, Prince Charles Hospital, Cardiff, UK
- Newcastle University (GB)
- Cardiff University (GB)
- British Thyroid Foundation (GB)
- University of Dundee (GB)
- Queen Elizabeth Hospital (GB)
- Corresponding author
- Wilkes, Scott
- ORCID
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2018-02
- Volume
- 8
- Issue
- 2
- Pages
- e019970
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC5855452
- OpenAlex
- W2789917159
- Cited by
- 31
- References
- 44
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 3 · 2022: 7 · 2021: 6 · 2020: 5 · 2019: 4 · 2018: 1
- FWCI
- 3.18
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
- Sunderland Repository (University of Sunderland) (acceptedVersion)
- Discovery Research Portal (University of Dundee) (submittedVersion, cc-by-nc)
- Newcastle University ePrints (Newcastle Univesity) (cc-by-nc)
- Funders
- Amdipharm Mercury Company Limited
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- hypothyroidism, levothyroxine, thyroid hormone replacement, general practice, clinician attitudes, general practitioners, pharmacists, practice nurses, theory of planned behavior, drug interactions, continuity of care, patient education, drug prescribing, suboptimal treatment
- MeSH terms
- Adult, England, Female, Health Personnel, Humans, Hypothyroidism, Interviews as Topic, Health Knowledge, Attitudes, Practice, Male, Middle Aged, Nurse Practitioners, Pharmacists, Professional Competence, Empirical Research, General Practitioners
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