A critical issue for primary care practice: knowledge and attitudes of family physicians regarding levothyroxine use
Abstract
Objective: Accurate management of hypothyroidism, which is one of the common reasons for referral to primary care, is critically important issue. This study aims to measure the knowledge and attitudes of family physicians (FPs) regarding the use of levothyroxine, which is the main pharmacological agent in the treatment of hypothyroidism.
Methods: This prospective and descriptive study was performed on 102 physicians from family health centers in Şanlıurfa province central districts. The researchers created a questionnaire consisting of eight questions; seven of which were multiple choices and one was open-ended, by scanning the guidelines and literature. Data were obtained by face-to-face interview technique.
Results: Of the participants, 21 (20.6%) were female and 81 (79.4%) male physicians, and the mean age of the participants was 36.9±8.0 (28-66) years. The work duration as a FP was 6.1±3.3 years. Sixteen (15.7%) of the participants reported that they had never prescribed levothyroxine. Two-thirds of them correctly answered the relationship between levothyroxine absorption and food intake, and 36.3% correctly answered that there would be a difference in absorption between different levothyroxine formulations. However, the rate of correct answers to the question of how to start hypothyroidism treatment in patients over 60 years of age or with coronary artery disease was quite low.
Conclusions: The results of this study revealed that FPs in Sanliurfa central districts do not have adequate knowledge about the use of levothyroxine for treatment of hypothyroidism, and they need effective training on this vital issue.
duyduklarını ortaya koymuştur.
Keywords
References
- 1. Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism. Lancet. 2017; 390 (10101): 1550-62.
- 2. Benvenga S, Carlé A. Levothyroxine formulations: pharmacological and clinical implications of generic substitution. Adv Ther. 2019; 36(2): 59-71.
- 3. Bolk N, Visser TJ, Nijman J, Jongste IJ, Tijssen JG, Berghout A. Effects of evening vs morning levothyroxine intake: a randomized double-blind crossover trial. Arch Intern Med. 2010; 170 (22): 1996-2003.
- 4. Chiovato L, Magri F, Carlé A. Hypothyroidism in context: where we’ve been and where we’re going. Adv Ther. 2019; 36(2): 47-58.
- 5. Jonklaas J, Bianco AC, Bauer AJ, Burman KD, Cappola AR, Celi FS, et al. Guidelines for the treatment of hypothyroidism: prepared by the American Thyroid Association task force on thyroid hormone replacement. Thyroid. 2014; 24(12): 1670-1751.
- 6. Chakera AJ, Pearce SH, Vaidya B. Treatment for primary hypothyroidism: current approaches and future possibilities. Drug Des Devel Ther 2012; 6: 1-11.
- 7. Liwanpo L, Hershman JM. Conditions and drugs interfering with thyroxine absorption. Best Pract Res Clin Endocrinol Metab. 2009; 23(6): 781-92.
- 8. Gaitonde DY, Rowley KD, Sweeney LB. Hypothyroidism: an update. Am Fam Physician. 2012; 86(3): 244-51.
- 9. Toloza FJK, Espinoza Suarez NR, Kawkgi OE, Golembiewski EH, Ponce OJ, Yao L, et al. Patient experiences and perceptions associated with the use of desiccated thyroid extract. Medicina. 2020; 56(4): 161.
- 10. Toloza FJK, Theriot SE, Singh Ospina NM, Nooruddin S, Keathley B, Johnson SM, et al. Knowledge, attitudes, beliefs, and treatment burden related to the use of levothyroxine in hypothyroid pregnant women in the United States. Thyroid. 2021; 31(4): 669-77.
- 11. Dew R, King K, Okosieme OE, Pearce S, Donovan G, Taylor P, et al. Patients’ attitudes and perceptions towards treatment of hypothyroidism in general practice: an in-depth qualitative interview study. BJGP open. 2017; 1:2.
- 12. Rani TA, Zaman O, Islam T. Knowledge, attitude, and practices towards thyroid risk of women: A study in Barishal. IOSR-JHSS. 2020; 7(6): 5-14
- 13. Hamdoun MM, Buddi S, Hamad F. Knowledge, attitude, practice and therapy satisfaction in patients with Hypothyroidism in the UAE. PhD Thesis. Ajman University of Science & Technology. 2020.
- 14. Alhazmi AA, Alkhaldi BA, Alhazmi RA, Alzahrani AM, Damanhouri NK. A cross-sectional study to evaluate knowledge, attitude, and practice among Saudi patients with hypothyroidism in Makkah. Education. 2020; 45(63):35-6.
- 15. Kut A, Kalli H, Anil C, Mousa U, Gursoy A. Knowledge, attitudes and behaviors of physicians towards thyroid disorders and iodine requirements in pregnancy. J Endocrinol Invest. 2015; 38(10): 1057-64.
- 16. Askari S, Abdi H, Ahmadi S, Bahadoran Z, Amouzegar A. Knowledge of thyroid disorders during pregnancy among general practitioners in Iran. Int J Endocrinol Metab. 2017; 15(3): e55450. doi: 10.5812/ijem.55450.
- 17. Negro R, Dazzi D, Pezzarossa A. The management of thyroid disease by GPs. Fam Pract. 2001; 18(2): 195-8.
- 18. Hussien NN, Eldin RMB. Knowledge and attitude of doctors in primary care settings towards thyroid disorders: an interventional study. SJPH. 2021; 9(2): 36-42. DOI: 10.11648/j.sjph.20210902.11
- 19. Dew R, King K, Okosieme OE, Pearce SH, Donovan G, Taylor PN, et al. Attitudes and perceptions of health professionals towards management of hypothyroidism in general practice: a qualitative interview study. BMJ Open. 2018; 8(2): e019970.
- 20. Kucukler FK, Akbaba G, Arduc A, Simsek Y, Guler S. Evaluation of the common mistakes made by patients in the use of Levothyroxine. Eur J Intern Med. 2014; 25(9): 107-8.
- 21. Vita R, Fallahi P, Antonelli A, Benvenga S. The administration of L-thyroxine as soft gel capsule or liquid solution. Expert Opin Drug Deliv 2014; 11(7): 1103-11.
- 22. Weetman A. Drug management of thyroid disorders in primary care. Prescriber. 2006; 17: 23-34.
- 23. Serin SO, İlhan M, Ahcı S, Okuturlar Y, Koç G, Eyüpgiller T, et al. Tiroid hastalıklarında bilinç düzeyi. Şişli Etfal Tıp Bülteni. 2016; 50 (3): 181-5.
- 24. Gibbons V, Lillis S, Conaglen J, Lawrenson R. The reality of subclinical hypothyroidism in general practice. Journal of primary health care. 2009; 1(3): 215-21.
- 25. Díez JJ. Hypothyroidism in patients older than 55 years: an analysis of the etiology and assessment of the effectiveness of therapy. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2002;57(5): 315-20.
- 26. Vaisman F, Coeli CM, Ward LS, Graf H, Carvalho G, Montenegro R et al.. How good is the levothyroxine replacement in primary hypothyroidism patients in Brazil? Data of a multicentre study. J Endocrinol Invest. 2013; 36: 485-8. 27. Díez JJ, Iglesias P, Gómez-Mateos MÁ. Management of primary hypothyroidism in adults: An analysis of the results of a survey in 546 primary care physicians. Endocrinologia, diabetes y nutricion. 2022;69(4): 289-98.
Birinci Basamak Uygulamaları İçin Kritik Bir Konu: Aile Hekimlerinin Levotiroksin Kullanımına İlişkin Bilgi ve Tutumları
Abstract
Amaç: Amaç: Birinci basamağa sık başvuru nedenlerinden biri olan hipotiroidinin doğru yönetimi kritik öneme sahip bir konudur. Bu çalışma, aile hekimlerinin hipotiroidi tedavisinde temel farmakolojik ajan olan levotiroksin kullanımına ilişkin bilgi ve tutumlarını ölçmeyi amaçlamaktadır.
Gereç ve Yöntem: Prospektif ve tanımlayıcı tipte olan bu çalışma, Şanlıurfa ili merkez ilçelerdeki aile sağlığı merkezlerinde görev yapan 102 aile hekimi üzerinde yapılmıştır. Araştırmacılar tarafından kılavuzlar ve literatür taranarak yedisi çoktan seçmeli ve biri açık uçlu sekiz sorudan oluşan bir anket oluşturuldu. Veriler yüz yüze görüşme tekniği ile elde edildi.
Bulgular:Katılımcıların 21'i (%20,6) kadın, 81'i (%79,4) erkek hekimdi ve yaş ortalaması 36,9±8,0 (28-66) idi. Aile hekimi olarak çalışma süresi 6,1±3,3 yıldı. Katılımcıların 16'sı (%15,7) hiç levotiroksin reçete etmediğini bildirdi. Üçte ikisi levotiroksin emilimi ile gıda alımı arasındaki ilişkiyi, %36,3'ü ise farklı levotiroksin formülasyonları arasında emilimde bir fark olup olmadığı sorusunu doğru yanıtladı. Ancak 60 yaş üstü veya koroner arter hastalığı olan hastalarda hipotiroidi tedavisine nasıl başlanacağını bilme oranı oldukça düşüktü.
Sonuç: Bu çalışmanın sonuçları, Şanlıurfa merkez ilçelerinde çalışan aile hekimlerinin hipotiroidi tedavisinde levotiroksin kullanımı konusunu yeterince bilmediklerini ve bu hayati konuda eğitime ihtiyaç duyduklarını ortaya koymuştur.
Keywords
References
- 1. Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism. Lancet. 2017; 390 (10101): 1550-62.
- 2. Benvenga S, Carlé A. Levothyroxine formulations: pharmacological and clinical implications of generic substitution. Adv Ther. 2019; 36(2): 59-71.
- 3. Bolk N, Visser TJ, Nijman J, Jongste IJ, Tijssen JG, Berghout A. Effects of evening vs morning levothyroxine intake: a randomized double-blind crossover trial. Arch Intern Med. 2010; 170 (22): 1996-2003.
- 4. Chiovato L, Magri F, Carlé A. Hypothyroidism in context: where we’ve been and where we’re going. Adv Ther. 2019; 36(2): 47-58.
- 5. Jonklaas J, Bianco AC, Bauer AJ, Burman KD, Cappola AR, Celi FS, et al. Guidelines for the treatment of hypothyroidism: prepared by the American Thyroid Association task force on thyroid hormone replacement. Thyroid. 2014; 24(12): 1670-1751.
- 6. Chakera AJ, Pearce SH, Vaidya B. Treatment for primary hypothyroidism: current approaches and future possibilities. Drug Des Devel Ther 2012; 6: 1-11.
- 7. Liwanpo L, Hershman JM. Conditions and drugs interfering with thyroxine absorption. Best Pract Res Clin Endocrinol Metab. 2009; 23(6): 781-92.
- 8. Gaitonde DY, Rowley KD, Sweeney LB. Hypothyroidism: an update. Am Fam Physician. 2012; 86(3): 244-51.
- 9. Toloza FJK, Espinoza Suarez NR, Kawkgi OE, Golembiewski EH, Ponce OJ, Yao L, et al. Patient experiences and perceptions associated with the use of desiccated thyroid extract. Medicina. 2020; 56(4): 161.
- 10. Toloza FJK, Theriot SE, Singh Ospina NM, Nooruddin S, Keathley B, Johnson SM, et al. Knowledge, attitudes, beliefs, and treatment burden related to the use of levothyroxine in hypothyroid pregnant women in the United States. Thyroid. 2021; 31(4): 669-77.
- 11. Dew R, King K, Okosieme OE, Pearce S, Donovan G, Taylor P, et al. Patients’ attitudes and perceptions towards treatment of hypothyroidism in general practice: an in-depth qualitative interview study. BJGP open. 2017; 1:2.
- 12. Rani TA, Zaman O, Islam T. Knowledge, attitude, and practices towards thyroid risk of women: A study in Barishal. IOSR-JHSS. 2020; 7(6): 5-14
- 13. Hamdoun MM, Buddi S, Hamad F. Knowledge, attitude, practice and therapy satisfaction in patients with Hypothyroidism in the UAE. PhD Thesis. Ajman University of Science & Technology. 2020.
- 14. Alhazmi AA, Alkhaldi BA, Alhazmi RA, Alzahrani AM, Damanhouri NK. A cross-sectional study to evaluate knowledge, attitude, and practice among Saudi patients with hypothyroidism in Makkah. Education. 2020; 45(63):35-6.
- 15. Kut A, Kalli H, Anil C, Mousa U, Gursoy A. Knowledge, attitudes and behaviors of physicians towards thyroid disorders and iodine requirements in pregnancy. J Endocrinol Invest. 2015; 38(10): 1057-64.
- 16. Askari S, Abdi H, Ahmadi S, Bahadoran Z, Amouzegar A. Knowledge of thyroid disorders during pregnancy among general practitioners in Iran. Int J Endocrinol Metab. 2017; 15(3): e55450. doi: 10.5812/ijem.55450.
- 17. Negro R, Dazzi D, Pezzarossa A. The management of thyroid disease by GPs. Fam Pract. 2001; 18(2): 195-8.
- 18. Hussien NN, Eldin RMB. Knowledge and attitude of doctors in primary care settings towards thyroid disorders: an interventional study. SJPH. 2021; 9(2): 36-42. DOI: 10.11648/j.sjph.20210902.11
- 19. Dew R, King K, Okosieme OE, Pearce SH, Donovan G, Taylor PN, et al. Attitudes and perceptions of health professionals towards management of hypothyroidism in general practice: a qualitative interview study. BMJ Open. 2018; 8(2): e019970.
- 20. Kucukler FK, Akbaba G, Arduc A, Simsek Y, Guler S. Evaluation of the common mistakes made by patients in the use of Levothyroxine. Eur J Intern Med. 2014; 25(9): 107-8.
- 21. Vita R, Fallahi P, Antonelli A, Benvenga S. The administration of L-thyroxine as soft gel capsule or liquid solution. Expert Opin Drug Deliv 2014; 11(7): 1103-11.
- 22. Weetman A. Drug management of thyroid disorders in primary care. Prescriber. 2006; 17: 23-34.
- 23. Serin SO, İlhan M, Ahcı S, Okuturlar Y, Koç G, Eyüpgiller T, et al. Tiroid hastalıklarında bilinç düzeyi. Şişli Etfal Tıp Bülteni. 2016; 50 (3): 181-5.
- 24. Gibbons V, Lillis S, Conaglen J, Lawrenson R. The reality of subclinical hypothyroidism in general practice. Journal of primary health care. 2009; 1(3): 215-21.
- 25. Díez JJ. Hypothyroidism in patients older than 55 years: an analysis of the etiology and assessment of the effectiveness of therapy. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2002;57(5): 315-20.
- 26. Vaisman F, Coeli CM, Ward LS, Graf H, Carvalho G, Montenegro R et al.. How good is the levothyroxine replacement in primary hypothyroidism patients in Brazil? Data of a multicentre study. J Endocrinol Invest. 2013; 36: 485-8. 27. Díez JJ, Iglesias P, Gómez-Mateos MÁ. Management of primary hypothyroidism in adults: An analysis of the results of a survey in 546 primary care physicians. Endocrinologia, diabetes y nutricion. 2022;69(4): 289-98.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration, Health Services and Systems (Other) |
| Journal Section | Articles |
| Authors | |
| Publication Date | October 20, 2023 |
| Acceptance Date | September 10, 2023 |
| Published in Issue | Year 2023 Volume: 15 Issue: 3 |
