Abstract

Objective To explore the attitudes and perceptions
of health professionals towards management of
hypothyroidism that contributes to the suboptimal
treatment of hypothyroidism in general practice.
Design A qualitative interview study using semistructured
interviews.
Participants Sixteen participants were interviewed
between March and August 2016 comprising nine general
practitioners (GPs), four pharmacists, two practice nurses
and one nurse practitioner.
Setting General practice and community pharmacies in
the counties of Northumberland, Tyne and Wear, Stocktonon-
Tees and North Cumbria, North of England, UK.
Method A grounded-theory approach was used to
generate themes from interviews, which were underpinned
by the theory of planned behaviour to give explanation to
the data.
Results Although health professionals felt that
hypothyroidism was easy to manage, GPs and nurses
generally revealed inadequate knowledge of medication
interactions and levothyroxine pharmacokinetics.
Pharmacists felt limited in the advice that they provide
to patients due to lack of access to patient records. Most
GPs and nurses followed local guidelines, and relied on
blood tests over clinical symptoms to adjust levothyroxine
dose. The information exchanged between professional
and patient was usually restricted by time and often
centred on symptoms rather than patient education.
Health professionals felt that incorrect levothyroxine
adherence was the main reason behind suboptimal
treatment, although other factors such as comorbidity
and concomitant medication were mentioned. Enablers
perceived by health professionals to improve the
management of hypothyroidism included continuity of
care, blood test reminders, system alerts for interfering
medications and prescription renewal, and accessible
blood tests and levothyroxine prescriptions for patients.
Conclusion There is a significant health professional
behavioural component to the management of
hypothyroidism. Addressing the differences in patient and
professional knowledge and perceptions could reduce the
barriers to optimal treatment, while continuity of care and
increased involvement of pharmacists and practice nurses
would help to promote optimal thyroid replacement.