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Improving the annual monitoring rates of testosterone replacement therapy patients in primary care

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bmjoq-2021-001784.pdf (694.8Kb)
Date
01/08/2022
Author
Hassoun, Omar
Starostka, Matt
Shearer, Heather
Millar, Angela
Hassoun, Salman
Isles, Chris
Keywords
RA Public aspects of medicine
NDAS
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Abstract
Introduction Testosterone replacement therapy (TRT) is the treatment of choice for male hypogonadism. British Society for Sexual Medicine (BSSM) guidelines on adult testosterone deficiency recommend that TRT patients undergo annual monitoring of their testosterone levels and potential complications of treatment; though evidence suggests that substantial numbers of men on TRT are not monitored adequately. Methods Review of the electronic patient record from a single general practice in southwest Scotland revealed that only 1 of 26 (4%) TRT patients had been monitored as per BSSM guidelines in the previous 12 months. Additionally, when monitoring was undertaken there was inconsistency in the blood tests requested. The use of quality improvement (QI) tools including process mapping and cause-and-effect diagram identified staff and patient knowledge of monitoring requirements and the lack of an effective recall system as areas for improvement. We tested three change ideas: the utilisation of an existing recall system for long-term therapies; a TRT Ordercomms blood group template (OBGT) to standardise monitoring; and a patient information leaflet (PIL) to improve patient education. The aim of this project was to achieve 60% annual monitoring rate. Results The percentage of patients monitored for testosterone levels and potential TRT complications increased from 4% (1/26) to 65% (17/26) over a 7-week test period. The utilisation of the existing recall system was a particularly effective intervention, leading to an increase from 4% (1/26) to 31% (8/26) in the first 2 weeks. Conclusion The use of QI tools was associated with over 60% of male TRT patients receiving comprehensive annual monitoring, as per BSSM guidelines. Our findings support the hypothesis that a patient recall system, combined with an OBGT and a PIL led to this increase.
Citation
Hassoun , O , Starostka , M , Shearer , H , Millar , A , Hassoun , S & Isles , C 2022 , ' Improving the annual monitoring rates of testosterone replacement therapy patients in primary care ' , BMJ Open Quality , vol. 11 , no. 3 , e001784 . https://doi.org/10.1136/bmjoq-2021-001784
Publication
BMJ Open Quality
Status
Peer reviewed
DOI
https://doi.org/10.1136/bmjoq-2021-001784
ISSN
2399-6641
Type
Journal article
Rights
Copyright © Author(s) (or their employer(s)) 2022. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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  • University of St Andrews Research
URI
http://hdl.handle.net/10023/25810

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