The goal of treatment in patients with primary hypothyroidism is to attain euthyroidism guided by the stipulated thyroid-stimulating hormone (TSH) levels range so as to minimize any potential long-term adverse effects. However, various factors may result in their Levothyroxine (T4) under and over-replacement.Our study aimed to evaluate the mean daily dose of L-T4 replacement for Asian patients with primary hypothyroidism. The secondary aims were to determine the proportion of those who were either over or under-replaced, and the factors associated with their thyroid function status and replacement adherence.Data collected using questionnaire survey from targeted patients managed in a typical public primary care center in Singapore: socio-demographic characteristics, clinical parameters, laboratory investigations, mean daily L-T4-replacement doses, and replacement regimens. The thyroid status of patients was classified based on thyroid function investigations.Complete data of 229 patients were analyzed. A total of 59.8% of patients had TSH within the normal range, 27.5% and 12.7% were under and over-replaced, respectively. About 60% of Asian patients with primary hypothyroidism achieved normal TSH status requiring average of 1.1 μg of daily L-T4/kgBW (kg body weight). Subjects who were over-replaced had a higher daily L-T4 dose/kgBW when compared to the euthyroid and the under replaced groups. Those with L-T4 over-replacement were largely due to excessive dosage. Patients who were younger, from lower socioeconomic strata, and higher BMI were more likely to be over or under-replaced.Majority of Asian patients with hypothyroidism required replacement of 1.1 μg of daily L-T4/kgBW. Their thyroid status was influenced by demographic and dosing factors.

Background Gout treatment is not optimized globally, often due to therapeutic inertia by physicians or poor adherence to urate‐lowering medications by patients. A patient decision aid (PDA) to facilitate shared decision making (SDM) in gout treatment may overcome these physician‐patient barriers. Objective The study explored the views of physicians and patients on a novel locally designed gout treatment PDA prototype. Design Qualitative descriptive design was used to gather data from in‐depth‐interviews (IDI) and focus group discussions (FGD). Data analysis was via thematic analysis. Emergent themes shaped a revised version of the PDA. Setting and participants Adult Asian patients with recent acute gout exacerbations and local Primary Care Physicians (PCP) in Singapore were purposefully chosen. 15 patients with gout and 11 PCPs participated across three IDIs and six FGDs, with the investigators exploring their views of a prototype gout treatment PDA. Results Patients and physicians generally concurred with the content and design of the PDA prototype. However, while patients preferred fewer treatment details, the PCPs desired more information. Patients preferred the display of statistics, while PCPs felt that numbers were not relevant to patients. The latter were hesitant to include treatment options that were unavailable in primary care. Both stakeholders indicated that they would use the PDA during a consultation. PCPs would need further training in SDM, given a lack of understanding of it. Conclusion and patient contribution Patients will be the prime users of the PDA. While their views differed partially from the physicians, both have jointly developed the novel gout treatment PDA.

AimThe study objective was to determine the levels of self-care (including domains of behaviour, motivation, self-efficacy) and health literacy, and study their associations amongst patients with chronic kidney disease (CKD) in primary care setting in Singapore.MethodA cross-sectional, questionnaire-based study was conducted in one public-sector primary care clinic. Participants aged 21 to 80 years with hypertension were recruited from the clinic CKD register with 5,500 patients. Self-care profile (including behaviour, motivation and self-efficacy) were measured using Hypertension Self-Care Profile (HTN-SCP, range 0-240, domain range 0-80). Health literacy was measured using Short-Form Health Literacy Scale (HLS-SF12, range 0-50, limited literacy ≤33).ResultsA total of 347 out of 354 randomly selected patients consented to participate in the study. Two hundred and eighty-nine fully-completed responses were analysed. The mean self-care (HTN-SCP) score was 182.7 (SD 23.2), while mean scores were 55.3 (SD 8.6), 63.3 (SD 8.7), 64.0 (SD 9.3), for behaviour, self-efficacy and motivation domains respectively. The mean health literacy score was 36.1 (SD 7.7), and 31.1% of participants had limited health literacy. Limited health literacy was associated with self-efficacy (OR= −7.2, 95%CI=−9.1 to −5.2, p<0.001), motivation (OR= −6.1, 95%CI=−8.3 to −3.9, p<0.001) and behaviour (OR= −4.5, 95%CI=−6.6 to −2.4, p<0.001). Self-care was not associated with age, CKD status, household income and education but was associated with gender and limited health literacy. In the final regression model only limited health literacy was associated with self-care scores (Adjusted beta −17.4, p<0.001).ConclusionOne-third of the patients with CKD in primary care had limited health literacy. Self-care was not associated with age, gender, CKD status, household income or education. Limited health literacy was associated with self-care, with strongest association with self-efficacy, followed by motivation and behaviour. More targeted approach can be adopted to improve self-care and health literacy amongst patients with CKD.