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Patient Requests for Tests and Treatments Impact Physician Management of Hypothyroidism.
Thyroid 2019T

Abstract

BACKGROUND

Levothyroxine is one of the most commonly prescribed medications in the United States. Although prior research focused on over- and undertreatment and patient dissatisfaction with thyroid hormone, little is known about physician reported barriers to managing thyroid hormone therapy. Additionally, the impact of patient requests for tests and treatments on hypothyroidism management remains unexplored.

METHODS

We randomly surveyed physician members of the Endocrine Society, American Academy of Family Practice and American Geriatrics Society. Respondents were asked to rate barriers to management of thyroid hormone therapy. We conducted multivariable logistic regression analyses to determine correlates with physician report of the most commonly reported barriers, including patient requests.

RESULTS

Response rate was 63% (359/566). Almost half of physicians reported that patient requests for tests and treatments were somewhat to very likely to be a barrier to appropriate management of thyroid hormone therapy (46%). Endocrinologists [odds ratio (OR), 2.29; 95% confidence interval (CI), 1.03-5.23, compared to primary care physicians] and physicians with more than 25% of patients on thyroid hormone therapy per year (OR, 1.90; 95% CI, 1.05-3.46, compared to those with <25% patients per year) were more likely to report patient requests as a barrier. Physicians with more years in practice were less likely to do so (11-20 years: OR, 0.44; 95% CI, 0.21-0.89; >20 years: OR, 0.24; 95% CI, 0.12-0.46, compared to ≤10 years). Physician reported patient requests included requests for preparations other than synthetic thyroxine (52%), adjusting thyroid hormone dose based on symptoms when biochemically euthyroid (52%), maintaining thyrotropin level (TSH) below normal range (32%) and adjusting dose according to serum T3 level (21%). Physicians who reported receiving patient requests for the former three unconventional practices were more likely to execute them (p<0.001, p=0.014, p<0.001, respectively).

CONCLUSION

Physicians reported patient requests for tests and treatments as a common barrier to appropriate thyroid hormone management. In some scenarios, physician adherence to patient requests may be a driver for inappropriate care and lead to harm. Understanding physician reported barriers to thyroid hormone management and factors associated with physician perception that patient requests are a barrier is key to improving patient care.

Authors+Show Affiliations

University of Michigan, 1259, Ann Arbor, Michigan, United States; nazanene@med.umich.edu.University of Michigan, 1259, Ann Arbor, Michigan, United States; dareyesg@med.umich.edu.University of Michigan, 1259, Ann Arbor, Michigan, United States; sarahawl@med.umich.edu.University of Michigan, 1259, Ann Arbor, Michigan, United States; meganhay@umich.edu.University of Michigan, 1259, Ann Arbor, Michigan, United States; mpapaleo@med.umich.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31436135

Citation

Esfandiari, Nazanene, et al. "Patient Requests for Tests and Treatments Impact Physician Management of Hypothyroidism." Thyroid : Official Journal of the American Thyroid Association, 2019.
Esfandiari N, Reyes-Gastelum D, Hawley ST, et al. Patient Requests for Tests and Treatments Impact Physician Management of Hypothyroidism. Thyroid. 2019.
Esfandiari, N., Reyes-Gastelum, D., Hawley, S. T., Haymart, M. R., & Papaleontiou, M. (2019). Patient Requests for Tests and Treatments Impact Physician Management of Hypothyroidism. Thyroid : Official Journal of the American Thyroid Association, doi:10.1089/thy.2019.0383.
Esfandiari N, et al. Patient Requests for Tests and Treatments Impact Physician Management of Hypothyroidism. Thyroid. 2019 Aug 22; PubMed PMID: 31436135.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patient Requests for Tests and Treatments Impact Physician Management of Hypothyroidism. AU - Esfandiari,Nazanene, AU - Reyes-Gastelum,David, AU - Hawley,Sarah T, AU - Haymart,Megan R, AU - Papaleontiou,Maria, Y1 - 2019/08/22/ PY - 2019/8/23/entrez JF - Thyroid : official journal of the American Thyroid Association JO - Thyroid N2 - BACKGROUND: Levothyroxine is one of the most commonly prescribed medications in the United States. Although prior research focused on over- and undertreatment and patient dissatisfaction with thyroid hormone, little is known about physician reported barriers to managing thyroid hormone therapy. Additionally, the impact of patient requests for tests and treatments on hypothyroidism management remains unexplored. METHODS: We randomly surveyed physician members of the Endocrine Society, American Academy of Family Practice and American Geriatrics Society. Respondents were asked to rate barriers to management of thyroid hormone therapy. We conducted multivariable logistic regression analyses to determine correlates with physician report of the most commonly reported barriers, including patient requests. RESULTS: Response rate was 63% (359/566). Almost half of physicians reported that patient requests for tests and treatments were somewhat to very likely to be a barrier to appropriate management of thyroid hormone therapy (46%). Endocrinologists [odds ratio (OR), 2.29; 95% confidence interval (CI), 1.03-5.23, compared to primary care physicians] and physicians with more than 25% of patients on thyroid hormone therapy per year (OR, 1.90; 95% CI, 1.05-3.46, compared to those with <25% patients per year) were more likely to report patient requests as a barrier. Physicians with more years in practice were less likely to do so (11-20 years: OR, 0.44; 95% CI, 0.21-0.89; >20 years: OR, 0.24; 95% CI, 0.12-0.46, compared to ≤10 years). Physician reported patient requests included requests for preparations other than synthetic thyroxine (52%), adjusting thyroid hormone dose based on symptoms when biochemically euthyroid (52%), maintaining thyrotropin level (TSH) below normal range (32%) and adjusting dose according to serum T3 level (21%). Physicians who reported receiving patient requests for the former three unconventional practices were more likely to execute them (p<0.001, p=0.014, p<0.001, respectively). CONCLUSION: Physicians reported patient requests for tests and treatments as a common barrier to appropriate thyroid hormone management. In some scenarios, physician adherence to patient requests may be a driver for inappropriate care and lead to harm. Understanding physician reported barriers to thyroid hormone management and factors associated with physician perception that patient requests are a barrier is key to improving patient care. SN - 1557-9077 UR - https://www.unboundmedicine.com/medline/citation/31436135/Patient_Requests_for_Tests_and_Treatments_Impact_Physician_Management_of_Hypothyroidism L2 - https://www.liebertpub.com/doi/full/10.1089/thy.2019.0383?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -