Moretti Brandon, Livecchi Rachel, Taylor Stephanie R, Pitt Susan C, Gay Brittany L, Haymart Megan R, Bhan Arti, Perkins Jennifer, Papaleontiou Maria
Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Department of Internal Medicine, Mercy Health - St. Vincent Medical Center, Toledo, Ohio, USA.
J Am Geriatr Soc. 2025 Feb;73(2):566-573. doi: 10.1111/jgs.19219. Epub 2024 Oct 11.
Thyroid hormone is one of the most commonly prescribed medications in the United States. Misuse of and overtreatment with thyroid hormone is common in older adults and can lead to cardiovascular and skeletal adverse events. Even though deprescribing can reduce inappropriate care, no studies have yet explored specific barriers and facilitators to guide thyroid hormone deprescribing in older adults (defined as discontinuation of thyroid hormone when initiated without an appropriate indication or dose reduction in those overtreated).
We conducted semi-structured interviews with 19 endocrinologists, geriatricians, and primary care physicians who prescribe thyroid hormone. Interviews were completed between July 2020 and December 2021 via two-way video conferencing. We used both an inductive and deductive content analysis guided by the Theoretical Domains Framework to evaluate transcribed and coded participant responses. Thematic analysis characterized themes related to barriers and facilitators to thyroid hormone deprescribing practices in older adults.
The most commonly reported barriers to thyroid hormone deprescribing were related to patient-level factors, followed by physician- and system-level factors. Patient factors included patients' perceived need for thyroid hormone use and patient anxiety/concerns about potential side effects related to thyroid hormone dose reduction, patient lack of knowledge, and misinformation regarding deprescribing. Physician- and system-level barriers included clinic visit time constraints, physician inertia, physician lack of knowledge about deprescribing, perceived lack of sufficient patient follow-up, and electronic health record limitations. The most prominent physician-reported facilitators to thyroid hormone deprescribing were effective physician-to-patient communication, and positive physician-patient relationship, including patients' trust in their treating physician.
Barriers and facilitators to thyroid hormone deprescribing in older adults were reported at multiple levels including patient-, physician-, and system-level factors. Interventions to improve thyroid hormone deprescribing in older adults should aim to improve patient education and expectations, increase multidisciplinary physician awareness, and overcome physician inertia.
甲状腺激素是美国最常用的处方药之一。老年人中甲状腺激素的滥用和过度治疗很常见，可能导致心血管和骨骼不良事件。尽管逐渐减少用药可以减少不适当的治疗，但尚无研究探讨指导老年人甲状腺激素逐渐减少用药的具体障碍和促进因素（定义为在无适当指征的情况下开始使用甲状腺激素后停药，或对过度治疗的患者减少剂量）。
我们对19位开具甲状腺激素处方的内分泌科医生、老年病科医生和初级保健医生进行了半结构化访谈。访谈于2020年7月至2021年12月通过双向视频会议完成。我们使用由理论领域框架指导的归纳和演绎内容分析来评估转录和编码的参与者回复。主题分析确定了与老年人甲状腺激素逐渐减少用药实践的障碍和促进因素相关的主题。
甲状腺激素逐渐减少用药最常报告的障碍与患者层面的因素有关，其次是医生和系统层面的因素。患者因素包括患者对使用甲状腺激素的感知需求、患者对甲状腺激素剂量减少潜在副作用的焦虑/担忧、患者知识缺乏以及关于逐渐减少用药的错误信息。医生和系统层面的障碍包括门诊就诊时间限制、医生惰性、医生对逐渐减少用药缺乏了解、认为缺乏足够的患者随访以及电子健康记录的局限性。医生报告的甲状腺激素逐渐减少用药最突出的促进因素是有效的医患沟通和积极的医患关系，包括患者对治疗医生的信任。
老年人甲状腺激素逐渐减少用药的障碍和促进因素在多个层面被报告，包括患者、医生和系统层面的因素。改善老年人甲状腺激素逐渐减少用药的干预措施应旨在提高患者教育和期望、提高多学科医生的认识并克服医生惰性。
