An Italian Survey of Compliance With Major Guidelines for L-Thyroxine of Primary Hypothyroidism

Vezzani, Silvia; Giannetta, Elisa; Altieri, Barbara; Barbonetti, Arcangelo; Bellastella, Giuseppe; Certo, Rosaria; Cignarelli, Angelo; Cinti, Francesca; D’Andrea, Settimio; Dalmazi, Giulia Di; Frara, Stefano; Garelli, Silvia; Giuffrida, G; Maiorino, Maria Ida; Mele, Chiara; Mezza, Teresa; Pani, Maria Grazia; Samà, Maria Teresa; Satta, Chiara; Santi, Daniele

doi:10.4158/ep-2017-0159

Cited by 15 publications

(14 citation statements)

References 26 publications

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“…Briesacher et al ( 20 ), using health care claims data, reported therapeutic adherence of 36.8%, whereas Crilly and Esmail ( 21 ) reported 78% adherence, similar to our data. This result was also observed by Vezzani et al ( 19 ) who reported medium-high adherence in 76.1% of patients with hypothyroidism. Moreover, these percentages were confirmed among pregnant women with hypothyroidism ( 22 ).…”

Section: Discussionsupporting

confidence: 86%

“…Our study does not confirm these data; no differences between patients taking tablet and liquid LT4 formulations were seen. This was also recently demonstrated in the EDIPO study in which no correlation was seen between adherence to treatment and LT4 formulation ( 19 ). Although a large cohort of patients was included in the retrospective survey by Hepp et al ( 23 ), adherence was calculated from the Truven's Health Analytic MarcketScan Commercial Claim database, which consists of the health care records of millions of commercially insured individuals.…”

Section: Discussionsupporting

confidence: 67%

“…Since its development, the MMAS-8 has been used in more than 200 randomized controlled trials of medical adherence interventions regarding numerous chronic diseases ( 18 ). The Italian version has recently been validated in a survey investigating the management of newly diagnosed hypothyroidism compared with the recommendations of the American Thyroid Association, American Association of Clinical Endocrinologists, and European Thyroid Association guidelines ( 19 ).…”

Section: Discussionmentioning

confidence: 99%

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Adherence to Levothyroxine Treatment Among Patients With Hypothyroidism: A Northeastern Italian Survey

et al. 2018

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Background: A significant number of patients show sub-optimal adherence to levothyroxine (LT4) therapy, mainly because they have to postpone their breakfast by at least 30 min. The aim of this observational cross-sectional study was to assess the therapeutic compliance of patients on LT4 treatment and to verify the preference of a lifetime treatment in tablet or liquid form.Patients and Methods: Ambulatory care patients aged 18 years or older, affected by hypothyroidism and on LT4 treatment (in tablet or liquid form) were administered the eight-item Morisky Medication Adherence Scale (MMAS-8). The MMAS-8 questionnaire was supplemented with 3 further items to specifically evaluate preference between tablet and liquid forms of LT4 for lifetime treatment.Results: A total of 320 patients (272 female), median age 47.9 ± 15.6 years (range, 20–78 years), completed the MMAS-8 questionnaire. Eighty-seven percent of the participants were adhering to their treatment for both tablet and liquid LT4 formulations, although significant differences emerged. Patients on LT4 tablets forgot to take their medication more frequently (p < 0.001), felt hassled about sticking to their treatment plan (p < 0.001), and had difficulty remembering to take all their medication(s) (p < 0.001) than those on liquid LT4 treatment.Conclusions: Adherence to LT4 treatment was high for both tablet and liquid formulations. Taking LT4 at breakfast was the most convenient option for most patients.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

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Adherence to Levothyroxine Treatment Among Patients With Hypothyroidism: A Northeastern Italian Survey

et al. 2018

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“…Vezzani et al examined guideline adherence in adult patients with primary hypothyroidism [18]. Here, a satisfactory adherence to the European recommendations was found, with the exception of the L-T 4 starting dose.…”

Section: Discussionmentioning

confidence: 89%

Guideline Adherence and Registry Recruitment of Congenital Primary Hypothyroidism: Data From the German Registry for Congenital Hypothyroidism (HypoDok)

Thomann

Voß

Oeverink

et al. 2020

Preprint

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Background: Neonatal screening for congenital primary hypothyroidism (CH) is mandatory in Germany but medical care thereafter remains inconsistent. Therefore, the multicentre database HypoDok was analysed to evaluate the implementation of evidence-based guidelines in the care of children with CH and to assess the number of patients in this registry of the German society of paediatric endocrinology and diabetology (DGKED).Methods: HypoDok includes the prospective documentation of 1,630 patients with CH from 50 centres in Germany and Austria. Inclusion criteria were (i) date of birth between 10/2001 and 05/2020 and (ii) increased TSH at screening and/or confirmation. Parameters regarding diagnosis, therapy and follow-up were extracted. The number of registered patients was compared to the number in the report of the German Society for Neonatal Screening (DGNS). The cohort was divided into 2 groups, before (A) and after (B) guideline publication in 02/2011, to assess guideline’s influence on medical care.Results: 659 patients (62% female) were eligible and analysed as group A (n=327) and group B (n=332) representing 17.5% and 6.7% of CH patients identified in the German and Austrian neonatal screening program during the respective time period. Treatment start and thyroxin doses were similar in both groups and consistent with recommendations. Regular follow-ups were documented in both groups including five appointments in the first and three in the second year of life. Ultrasound of the thyroid gland was performed in 92.6% (A) and 92.1% (B) of the patients. In the first three years of life, 46.4% (A) and 40.0% (B) of the patients underwent audiometry, EQ/IQ testing was performed in 49.3% (A) and 24.8% (B) (p<0.01), respectively.Summary: While documentation of care for patients with CH by paediatric endocrinologists seems to be established, only a minority of all affected patients is included in HypoDok. Thus, the care and outcome of the majority of patients with CH remains uncertain. Therefore, comprehensive documentation as an important instrument of quality assurance and evidence-based medicine should be legally enforced and officially funded in order to record, comprehend and optimize care and outcome in patients with rare diseases such as CH, irrespective of treatment provider.

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“…Vezzani et al examined guideline adherence in adult patients with primary hypothyroidism [22]. Here, a satisfactory adherence to the European recommendations was found, with the exception of the L-T4 starting dose.…”

Section: Discussionmentioning

confidence: 90%

Guideline Adherence and Registry Recruitment of Congenital Primary Hypothyroidism: Data from the German Registry for Congenital Hypothyroidism (HypoDok)

Thomann

Voß

Oeverink

et al. 2021

IJNS

View full text Add to dashboard Cite

Neonatal screening for congenital primary hypothyroidism (CH) is mandatory in Germany but medical care thereafter remains inconsistent. Therefore, the registry HypoDok of the German Society of Pediatric Endocrinology and Diabetology (DGKED) was analyzed to evaluate the implementation of evidence-based guidelines and to assess the number of included patients. Inclusion criteria were (i) date of birth between 10/2001 and 05/2020 and (ii) increased thyroid-stimulating hormone (TSH) at screening and/or confirmation. The cohort was divided into before (A) and after (B) guideline publication in 02/2011, to assess the guideline’s influence on medical care. A total of 659 patients were analyzed as group A (n = 327) and group B (n = 332) representing 17.5% and 10.3% of CH patients identified in the German and Austrian neonatal screening program during the respective time period. Treatment start and thyroxine doses were similar in both groups and consistent with recommendations. Regular follow-ups were documented. In the first three years of life, less than half of the patients underwent audiometry; developmental assessment was performed in 49.3% (A) and 24.8% (B) (p < 0.01). Documentation of CH patient care by pediatric endocrinologists seemed to be established, however, it reflected only a minority of the affected patients. Therefore, comprehensive documentation as an important instrument of quality assurance and evidence-based medicine should be legally enforced and officially funded in order to record, comprehend, and optimize care and outcome in patients with rare diseases such as CH.

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An Italian Survey of Compliance With Major Guidelines for L-Thyroxine of Primary Hypothyroidism

Cited by 15 publications

References 26 publications

Adherence to Levothyroxine Treatment Among Patients With Hypothyroidism: A Northeastern Italian Survey

Adherence to Levothyroxine Treatment Among Patients With Hypothyroidism: A Northeastern Italian Survey

Guideline Adherence and Registry Recruitment of Congenital Primary Hypothyroidism: Data From the German Registry for Congenital Hypothyroidism (HypoDok)

Guideline Adherence and Registry Recruitment of Congenital Primary Hypothyroidism: Data from the German Registry for Congenital Hypothyroidism (HypoDok)

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