Endocrine Abstracts

Introduction: Thyroid quality indicators were removed from the Quality Outcome Framework (QOF) targets in 2014, resulting in discontinuation of statutory system alerts to remind GPs to check annual thyroid function in patients with primary hypothyroidism treated with levothyroxine.

Aim: To investigate the impact of the discontinuation and reinstitution of the QOF thyroid e-alerts on the management of hypothyroidism in primary care.

Methods: Following exclusion of hypothyroidism from QOF indicators in 2014, we developed an electronic protocol in Emis Web to emulate the QOF thyroid e-alerts. We piloted these alerts in a single Surrey GP practice (patient population 8057, n=257 with treated hypothyroidism). In 2016, we audited, in the population meeting the QOF criteria for inclusion in the thyroid register (Thy001), the percentage of patients who 1) had had TSH checked in the preceding 12 months (Thy002) and (2) had latest TSH level within the local laboratory reference range of 0.35–5.0 mU/L. We compared standards in the pilot practice with those in 4 control practices without alerts (total population 63,534 [range 7070–33,314]; n=1953 with treated hypothyroidism).

Results: During the period of statutory hypothyroidism alerts (2009–2014), 98–100% of patients with hypothyroidism in both pilot and control practices met QOF Thy002 requirement. Following removal of hypothyroidism from QOF, 90% of hypothyroid patients in the pilot practice with electronic alerts had a 12-month TSH check compared with 77% in control practices without alerts. However, the proportion of patients with TSH within the reference range was similar in pilot and control practices (67% vs. 69%).

Conclusion: The removal of hypothyroidism from the QOF targets has been associated with deterioration in TSH monitoring in primary care. An electronic protocol replicating QOF Thy002 alerts improves thyroid monitoring but not biochemical control of hypothyroidism. An e-protocol to prompt action when TSH is outside the reference range in patients with treated hypothyroidism has been developed and is currently being piloted.