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Endocrine Abstracts (2011) 25 P283

Steroids

GPs say they rely on endocrinologists to manage adrenal crisis and patient education for Addison’s disease

Katherine White & Alick Mackay

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Addison’s Disease Self-Help Group, Guildford, UK.


In early 2010, the Addison’s Disease Self-Help Group sent an information pack to 10 500 GP practices across the UK, outlining the GP’s role in diagnosis and care of the Addison’s patient. We asked the practice head to return a reply-paid questionnaire, detailing the number of steroid-dependent patients in the practice, their repeat prescription length, if they had an in-date supply of injectable hydrocortisone, and any comments on the challenges they faced in providing care for their steroid-dependent patients.

Predictably, only a tiny proportion of GP practices sent a reply (n=22), so that their responses do not offer statistical validity. Nevertheless, this small sample offers some qualitative insights.

The 22 GP practices that replied contained an average of 4.4 GPs, 6700 patients and 1.7 Addison’s patients. This is only a slightly higher proportion than epidemiological research would have suggested.

Thirty-three percent of practices with steroid-dependent patients (n=18) reported that they were on 28-day repeat prescriptions. Only 3 of these practices were able to confirm that their patients had an in-date supply of injectable hydrocortisone.

Several GPs stated that prevention and management of adrenal crisis was their biggest challenge, as neither practice staff nor their adrenal patients had a good understanding of what this entailed. Others said they had insufficient experience to offer guidance to the patient on what to do if they became unwell and relied on patients to ‘self-care’. One respondent commented that he had yet to see an adrenal patient after 30 years as a GP, and would rely on secondary care to provide the follow-up and patient education required.

This small survey reinforces the importance of the endocrinologist’s role in providing patient education for the prevention and management of adrenal crisis.

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