Endocrine Abstracts

Objective: An audit comparing how the treatment of hypothyroidism has changed since the introduction of the Quality Outcome Framework (QOF) in April 2004 according to UK guidelines published by the Association of Clinical Biochemists and the British Thyroid Association (BTA) in 2005.

Method: Data were collected from all patients with primary hypothyroidism in a fully computerized practice of 9830 patients under the care of 9 general practitioners. The most recent thyroid stimulating hormone (TSH) measurement was noted for the 2 years preceding October 2008 and for the 2 years preceding October 2003.

Results: From 2003 to 2008 the number of patients with primary hypothyroidism had increased from 163 to 244. In October 2003, 27.6% of these patients had their TSH measured in the preceding 2 years compared to 98% in the 2 years preceding October 2008. Despite this 37.8% of patients in 2003 had a TSH within the target range (0.4–2.5 miu/l) compared to 35.2% in 2008. About 53.3% of patients had a TSH within the local reference range for TSH (0.4–5.6 miu/l) compared to 58.1% of patients in 2008. About 24.4% of patients in 2003 had a suppressed TSH (<0.4 miu/l) in 2003 compared to 29.9% in 2008.

Conclusions: Introduction of the QOF for hypothyroidism (a register of patients and measurement of TSH every 15 months) has led to improved regular monitoring of TSH in primary care patients through computer generated recall of patients. However, this has not led to an improvement in outcomes as measured by TSH levels according to current BTA guidelines, presenting a challenge for primary care in an era when the care of more chronic diseases is moving into primary care.