Endocrine Abstracts

Background: In 2014, Thy002 (the proportion of patients with hypothyroidism on the practice register with thyroid function tests recorded in the preceding 12 months) was removed as a Quality Outcome Framework (QOF) target.

Aim: To audit the current management of hypothyroidism in primary care two years following the QOF changes.

Method: Four local practices (total patient population: 37 200 (range 7300–1300 per Practice)) participated in the audit. An EMIS web population search was performed of all patients coded with ‘hypothyroidism’ or recorded as having been issued with Levothyroxine in the previous 6 months whether or not they had been coded. The proportion meeting the previous Thy002 target was calculated. The latest TSH value was also assessed according to the local reference range (0.35–5 mU/l) to determine the proportion of patients with results within range.

Results: 1190 patients met the inclusion criteria; 1114 of these were coded with hypothyroidism (3% of total patient population). 80% of the coded group had had TSH checked within previous 12 months, compared with 100% prior to 2014. Levothyroxine was on repeat prescription in 97% of patients coded as having hypothyroidism and 92% of these had requested a prescription in the previous 6 months. The latest TSH was outside the local reference range in 33% of patients (32% >5 mU/l and 34% <0.1 mU/l). 7% of patients on Levothyroxine were not coded as having hypothyroidism, and 16% had not had thyroid function checked in the previous 12 months.

Conclusion: The removal of hypothyroidism from QOF targets has been associated with some deterioration in TSH monitoring in primary care. An EMIS web protocol with system alerts to remind about TSH check and also when TSH is outside local reference range has been developed to address areas needing improvement, and further studies will be carried out to assess its impact.