评估专用转诊和管理算法对孕产妇甲状腺功能减退症的影响。

IF 2.5 Q3 ENDOCRINOLOGY & METABOLISM
Jeremy A Knott, Michael J Bennett, Malgorzata M Brzozowska
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引用次数: 0

摘要

背景:妊娠期甲状腺功能减退症的重大风险可通过及时诊断和开始使用甲状腺素来减轻,从而使孕妇达到甲状腺功能正常状态。本研究旨在评估医院内分泌服务的效率,具体方法包括评估首次门诊预约前开始使用甲状腺素的比例、首次就诊时的中位胎龄、指南适用的检查比例、围产期结局,以及在实施专门的转诊和管理路径前后,达到目标促甲状腺激素(TSH)水平的转诊患者比例:在2020年4月1日至9月1日(干预前)和2021年4月1日至9月1日(干预后)两个时间段内,利用电子病历对转诊到医院门诊的前50名连续甲减患者进行了回顾性临床审计:实施路径后,TSH首次升高的妇女在首次就诊前获得甲状腺素处方的比例没有显著差异(P=0.83)。不过,首次 TSH 测量的时间提前了(中位数为 5.5 周对 6.5 周,P=0.011),专家复查的时间也提前了(中位数为 19 周对 22 周,P=0.032)。干预后接受甲状腺自身抗体检测的 TSH 升高女性明显增多(78% 对 55.5%,P=0.035)。围产期结果无明显差异。所有妇女都达到了目标 TSH 水平,最终 TSH 中位数为 1.6 mIU/L(IQR:1.2 至 2.3):虽然转诊患者在孕期达到目标 TSH 水平的比例保持不变,但某些服务效率指标有所提高。结论:虽然转诊患者在孕期达到目标 TSH 水平的比例没有变化,但某些服务效率却有所提高,其中包括更早地测量 TSH、更早地由内分泌专家进行复查,以及更多地对甲状腺自身抗体进行检测。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Assessing the impact of a dedicated referral and management algorithm in maternal hypothyroidism.

Background: The significant risks of hypothyroidism during pregnancy can be mitigated through timely diagnosis and initiation of thyroxine to achieve a maternal euthyroid state. This study aimed to evaluate the efficiency of hospital endocrine services by assessing the rate of thyroxine commencement before the initial clinic appointment, the median gestational age at the first consultation, the rate of guideline-appropriate investigations, perinatal outcomes, and the proportion of referred patients who achieved their target thyroid-stimulating hormone (TSH) levels before and after implementing a dedicated referral and management pathway.

Methods: A retrospective clinical audit was conducted using electronic medical records for the first fifty consecutive patients with hypothyroidism referred to the hospital clinic during two-time intervals: from April 1 to September 1, 2020 (pre-intervention) and from April 1 to September 1, 2021 (postintervention).

Results: Following the pathway implementation, there was no significant difference in the proportion of women with initially raised TSH who were prescribed thyroxine prior to the first clinic appointment (P=0.83). However, the first TSH measurement occurred earlier (median 5.5 vs. 6.5 weeks, P=0.011), and specialist reviews were conducted sooner (median 19 vs. 22 weeks, P=0.032). Significantly more women with elevated TSH underwent thyroid autoantibody testing postintervention (78% vs. 55.5%, P=0.035). There was no significant difference in perinatal outcomes. All women achieved their target TSH levels, with a median final TSH of 1.6 mIU/L (IQR: 1.2 to 2.3).

Conclusions: While the proportion of referred patients achieving target TSH levels during pregnancy remained unchanged, certain measures of service efficiency improved. These included earlier TSH measurement, earlier endocrinologist review, and increased detection of thyroid autoantibodies.

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CiteScore
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