Optimizing Care for Older Adults Through Thyroid Hormone Deprescribing

Reduction of thyroid hormone overtreatment, measured as proportion of patients who had their TSH normalized.

Reduction in thyroid hormone overtreatment will be measured via EMR based on serum TSH in the normal range (=\>0.5-6 mIU/L). We will assess TSH as a continuous variable and as a categorical variable (\<0.5, 0.5-6, \>6 mIU/L) to also delineate unintended TSH above the upper limit of normal.

Time frame: 6 months post-enrollment

Provider-reported knowledge

Assessed via surveys by provider report and defined as the composite score obtained from 4 items with response categories ranging from low to high (5-point Likert scale; 1: low to 5: high); higher scores indicate increased knowledge.

Time frame: 6-12 months post-enrollment

Provider-reported intent to deprescribe

Assessed via surveys by provider report (single item) with response categories ranging from low to high (5-point Likert scale; 1: very unlikely to 5: very likely).

Time frame: 6-12 months post-enrollment

Provider-reported self-efficacy

Assessed via provider surveys using the 9-item validated deprescribing self-efficacy survey designed to gain a better understanding of how providers rate their self-efficacy in deprescribing medications in their older adult patients (scale 0-100; higher scores indicate higher self-efficacy).

Time frame: 6-12 months post-enrollment

Patient-reported discussion of deprescribing with provider

Assessed via patient surveys by patient report and analyzed as a binary variable (yes/no).

Time frame: 3-6 months post-enrollment

Patient-reported knowledge

Assessed by patient surveys and will be defined as the percentage of correct answers (range 0-100%) from four questions regarding thyroid hormone therapy in older adults (true/false), where higher percentages indicate increased knowledge.

Time frame: 3-6 months post-enrollment

Patient-reported attitudes towards deprescribing

Assessed via patient surveys using the validated 22-item Revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire \[subscales: perceived burden of medication taking, concerns about stopping the medication, belief in appropriateness of medication use (harms / benefits), level of involvement / knowledge of medications\] and global questions. Questions pertaining to the burden, concerns about stopping, involvement in treatment, and global questions are scored such that a higher total score indicates a greater burden, concern, involvement, or agreement with global questions (5= strongly agree, 4= agree, 3= unsure, 2=disagree, 1= strongly disagree). Questions regarding the appropriateness factor were scored in reverse. In that case, a higher score indicates participants' belief in the appropriateness of their medications.

Time frame: 3-6 months post-enrollment

Patient-reported beliefs about medicines

Assessed via patient surveys using the validated 18-item Beliefs about Medicines Questionnaire (BMQ), with each item scored on a 5-point Likert scale (5= strongly agree, 4= agree, 3= unsure, 2=disagree, 1= strongly disagree). The BMQ is divided into BMQ-General (sub-scales: overuse and harm) and BMQ-Specific (subscales: necessity and concerns). Higher scores in the BMQ-General subscales indicate an overall negative perception of medications. Higher scores in the BMQ-Specific necessity subscale are indicative of a patient's need to adhere to medication to maintain health, while higher scores in the BMQ-Specific concerns subscale represent the notion that adverse reactions are potentially harmful when taking medication on a regular basis.

Time frame: 3-6 months post-enrollment