Endocrine Abstracts

Introduction: Following the introduction of the Quality Outcome Framework (QOF), 98–100% patients with hypothyroidism received annual TSH checks during the period 2009–2014. However, there was no evidence this resulted in improved care. We have developed an electronic protocol in EMIS web to both emulate the former QOF thyroid e-alerts in prompting GP’s to check annual thyroid function in patients with treated primary hypothyroidism, and also to alert if TSH is out of range.

Aim: To investigate the impact of an electronic protocol on the monitoring and management of levothyroxine replacement in patients treated for primary hypothyroidism in primary care.

Methods: The study population comprised five Surrey GP practices with a total population of 74,984 patients. The prevalence of primary hypothyroidism was 3.2% and did not change significantly over the course of the study. We analysed the percentage of patients who i) had had TSH checked in the preceding 12 months and ii) had latest TSH level within the local laboratory reference range (0.35–5.0 mU/l) at baseline and again 12 months after introduction of the electronic protocol.

Results: The proportion of patients with TSH checked in the previous 12 months increased from 77% to 83%. The latest TSH result was within local reference range in 68% (before) and 71% (after) introduction of the electronic thyroid e-alerts. The proportion of patients with TSH both within range and checked in last 12 months improved from 53% to 58%.

Conclusions: An electronic protocol which reminds GP’s to check thyroid function and alerts them to TSH values that are out of range resulted in modest improvements in monitoring and biochemical control of primary hypothyroidism. Although both may improve further over subsequent years, additional measures are likely required to achieve higher levels of monitoring and improvement in optimisationof thyroid hormone replacement.