Dew Rosie, King Kathryn, Okosieme Onyebuchi E, Pearce Simon H, Donovan Gemma, Taylor Peter N, Hickey Janis, Dayan Colin M, Leese Graham, Razvi Salman, Wilkes Scott
Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK.
Endocrinology and Diabetes Department, Prince Charles Hospital, Cardiff, UK.
BMJ Open. 2018 Feb 21;8(2):e019970. doi: 10.1136/bmjopen-2017-019970.
To explore the attitudes and perceptions of health professionals towards management of hypothyroidism that contributes to the suboptimal treatment of hypothyroidism in general practice.
A qualitative interview study using semistructured interviews.
Sixteen participants were interviewed between March and August 2016 comprising nine general practitioners (GPs), four pharmacists, two practice nurses and one nurse practitioner.
General practice and community pharmacies in the counties of Northumberland, Tyne and Wear, Stockton-on-Tees and North Cumbria, North of England, UK.
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.
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.
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.
探讨医疗保健专业人员对甲状腺功能减退症管理的态度和看法，这些态度和看法导致了全科医疗中甲状腺功能减退症的治疗效果欠佳。
采用半结构式访谈的定性访谈研究。
2016年3月至8月间对16名参与者进行了访谈，其中包括9名全科医生、4名药剂师、2名执业护士和1名执业护师。
英国英格兰北部诺森伯兰郡、泰恩-威尔郡、蒂斯河畔斯托克顿和北坎布里亚郡的全科医疗诊所和社区药房。
采用扎根理论方法从访谈中提炼主题，并以计划行为理论为依据对数据作出解释。
尽管医疗保健专业人员认为甲状腺功能减退症易于管理，但全科医生和护士普遍表现出对药物相互作用和左甲状腺素药代动力学的知识不足。药剂师感到由于无法获取患者记录，他们向患者提供的建议有限。大多数全科医生和护士遵循当地指南，依靠血液检查而非临床症状来调整左甲状腺素剂量。专业人员与患者之间交流的信息通常受时间限制，且往往集中在症状而非患者教育上。医疗保健专业人员认为左甲状腺素依从性不佳是治疗效果欠佳的主要原因，但也提到了其他因素，如合并症和同时服用的药物。医疗保健专业人员认为有助于改善甲状腺功能减退症管理的因素包括连续性护理、血液检查提醒、针对干扰药物和处方续签的系统警报，以及患者可获得的血液检查和左甲状腺素处方。
甲状腺功能减退症的管理中存在显著的医疗保健专业人员行为因素。解决患者与专业人员在知识和认知上的差异可减少达到最佳治疗效果的障碍，而连续性护理以及药剂师和执业护士更多的参与将有助于促进最佳的甲状腺替代治疗。
