Endocrine Abstracts (2016) 44 P236 | DOI: 10.1530/endoabs.44.P236

Increasing awareness of Graves' orbitopathy with [ldquo]Early Warning[rdquo] cards - a TEAMeD multicentre quality improvement project

Anna L Mitchell1,5, Nicola Zammitt3, Ramzi Ajjan4, Bijay Vaidya6, Janis Hickey7, Petros Perros5 & Colin Dayan2


1Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK; 2Institute of Molecular and Experimental Medicine, Cardiff University, Cardiff, UK; 3Department of Endocrinology, Royal Infirmary of Edinburgh, Edinburgh, UK; 4Department of Endocrinology, Leeds Teaching Hospitals NHS Trust, Leeds, UK; 5Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK; 6Department of Endocrinology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK; 7British Thyroid Foundation, Harrogate, UK.


Background: Clinically significant Graves’ orbitopathy (GO) develops in 20% of those with Graves’ Disease (GD). Up to 90% of cases present at the same time as, or after, hyperthyroidism develops. Most cases of GD in the UK are managed in endocrinology clinics. Despite this, patients report significant delays before a correct diagnosis of GO is made. We argued that measures to increase awareness of the early signs of GO in those with GD and establishing a fast-track referral pathway to specialist care should overcome these delays and improve outcomes.

Aims: (1) To determine whether issuing a “GO early warning card” to all patients with an established diagnosis of GD raises awareness of GO and facilitates early diagnosis.

(2) To determine what percentage of cards result in a telephone contact.

(3) To determine the number of “false reports” from card carriers.

Methods: We designed early warning cards, detailing common symptoms of GO and a telephone contact number for patients who develop eye symptoms. Cards were distributed to 171 patients with a diagnosis of GD, but without known GO, attending endocrine clinics in Newcastle, Exeter, Cardiff, Edinburgh and Leeds. We recorded telephone contacts over 3 months and feedback from patients regarding their experience of this initiative.

Results: Over 3 months, 10 telephone contacts were received (6% of cards issued). One patient called twice. 1/10 (10%) calls were managed with telephone advice alone, while the other 9 resulted in an additional clinic review. Overall, 4 diagnoses of GO were made. Feedback received to date suggests that most patients felt that having a card was useful and increased their awareness of GO.

Conclusions: In this pilot study, we found that it is feasible to distribute GO early warning cards to patients in busy endocrine clinics and that this does not result in an excessive burden of telephone enquiries. Patients generally appreciated the additional information offered and viewed the project positively.

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