Endocrine Abstracts

Introduction: Thyroid hormone replacement is frequently suboptimal but interventions that are proven to optimise therapy are lacking. In 2017, we developed in EMIS an electronic Protocol for Monitoring Patients on Thyroxine in General Practice (‘e-Prompt GP’), to offer automated alerts to prompt GP's to test and address out of range thyroid function tests in patients with hypothyroidism.

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

Methods: Five GP practices with a total population of 74,511 patients participated in this study. The prevalence of hypothyroidism was 3.3% and did not change significantly over the course of the study. We audited the percentage of patients who (i) 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 at 12 and 24 months after introduction of the ‘e-Prompt GP’ alerts.

Results: The proportion of patients with TSH checked in previous 12 months increased from 77% to 82% and 83% at 12 and 24 months respectively. The latest TSH was within local reference range in 68% (before) and 72% at both 12 and 24 months following introduction of the ‘e-Prompt GP’ alerts. The proportion of patients with TSH both within range and checked in last 12 months improved from 53% to 59% after 12 months and remained unchanged at 24 months.

Conclusions: An electronic protocol which prompts GP's to check thyroid function in patients with treated hypothyroidism and alerts them to TSH values that are out of range resulted in improvements which were sustained after 24 months of implementation. Further studies are needed to determine what other measures may be required to achieve further progress in optimisation of thyroid hormone replacement.