Quality of self-care in patients on replacement therapy with hydrocortisone

Abstract

Objectives. To assess the quality of self-care in patients receiving replacement therapy with hydrocortisone for primary or secondary adrenal insufficiency. Design. A questionnaire-based survey. Setting. The outpatient Clinic of Endocrinology at the University Hospital in Herlev, Denmark. Subjects. Ninety-seven patients identified from the case reports of the clinic. All patients had received repeated oral information about hydrocortisone treatment and dose adjustments. Eighty-four (87%) patients completed the questionnaire. Main outcome measures. Ability to act appropriately in case of physical stress, possession of a 'Steroid warning card', number and nature of episodes of physical stress during the past year and self-experienced level of information was recorded. Results. Thirty-nine (46%) of the patients were not sufficiently skilled in coping with physical stress. This was more prominent in the elderly patients. Seventeen (20%) did not possess a 'steroid warning card'. Thirty-seven (44%) had experienced at least one febrile episode and 24 (29%) had been admitted to hospital during the past year. Fifty (60%) felt themselves to be well informed, but this did not correlate with the ability to act appropriately. Conclusions. The study shows the need for continuous education of patients with adrenal insufficiency. Oral instructions should be supplemented with written information or a more detailed and structured education.