Endocrine Abstracts

Background: Adrenal insufficiency (AI) poses a significant health burden on patients, their families, and the healthcare system. Cost of illness for this patient population is four times higher than the general population. Hospital admissions due to adrenal crisis (AC) form a considerable proportion of this cost. Almost 1 in 200 patients die from AC. One in 12 patients with AI are hospitalised at least once a year following an acute AC episode if not treated promptly with parenteral hydrocortisone. Previous studies reported barriers to patient self-management at patient- and clinician- or service-level such as inadequate knowledge from patients and healthcare professionals, illness perceptions, delays in treating adrenal crisis. Out of hospital treatment of an adrenal crisis involves administration of hydrocortisone sodium phosphate (Efcortesol–liquid ampoule) or hydrocortisone sodium succinate (Solu-Cortef–powder vial) which require up to 20 sequential steps to prepare and administer intramuscularly. This can present significant challenges for patients whose health status is already severely compromised due to adrenal crisis.

Research Questions: What are the experiences of patients with AI on the management of an adrenal crisis? What are the barriers and enablers to managing adrenal crisis with the current hydrocortisone injection device?

Methods: This is a Qualitative research study using semi-structured 1:1 online interview for data collection. Adult patients with primary or secondary adrenal insufficiency and with a history of having experienced an adrenal crisis in the past 3 years are recruited via Pituitary Foundation and Addison’s Disease Self-Help Group in the UK. The study is underpinned by the COM-B (Capabilities, Opportunity, Motivation–Behaviour) behaviour change Model. A convenience sampling approach will be adopted aiming to recruit 12-15 participants by end of March 2023. Interviews will be conducted online via a secure University Zoom account, transcribed verbatim and will be analysed using deductive thematic analysis with COM-B as the framework for analysis.

Outcomes: The aim is to provide an understanding on the experience and perception of patients with AI in managing AC with the use of hydrocortisone injection device. Identifying and understanding the barriers and enablers in managing AC, will inform guidance for further improvements in patient self-management strategies in preventing and managing AC.