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

At baseline, only 1 of 26 TRT patients (4%) had been monitored as per BSSM guidelines in the previous 12 months.

• Data were obtained from electronic patient records at a single general practice in southwest Scotland.
• 26 TRT patients were identified in the practice.
• Only 1 patient (4%) had received monitoring compliant with BSSM guidelines.
• When monitoring was undertaken, there was inconsistency in the blood tests requested.

Three change ideas were identified and tested using quality improvement tools including process mapping and a cause-and-effect diagram.

• QI tools identified staff and patient knowledge of monitoring requirements and the lack of an effective recall system as key areas for improvement.
• The three change ideas were: 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 project aim was to achieve a 60% annual monitoring rate.
• The test period lasted 7 weeks.

Utilisation of the existing recall system alone increased the monitoring rate from 4% to 31% within the first 2 weeks.

• Monitoring rate increased from 1/26 (4%) to 8/26 (31%) following introduction of the recall system.
• This increase occurred within the first 2 weeks of the intervention period.
• The recall system was described as 'a particularly effective intervention'.

The combined interventions increased the percentage of TRT patients receiving comprehensive annual monitoring from 4% to 65% over the 7-week test period.

• Monitoring rate increased from 1/26 (4%) to 17/26 (65%) over 7 weeks.
• This exceeded the project's stated aim of achieving a 60% annual monitoring rate.
• The increase was attributed to the combination of the recall system, the OBGT, and the PIL.
• The OBGT was introduced to standardise the blood tests requested during monitoring.

BSSM guidelines recommend annual monitoring of testosterone levels and potential complications of treatment for all TRT patients.

• Guidelines referenced are from the British Society for Sexual Medicine (BSSM) on adult testosterone deficiency.
• Evidence cited in the paper suggests that substantial numbers of men on TRT are not monitored adequately.
• TRT is described as the treatment of choice for male hypogonadism.