From guidelines to hospital practice: reducing inappropriate ordering of thyroid hormone and antibody tests

Toubert, Marie Elisabeth; Chevret, Sylvie; Cassinat, Bruno; Schlageter, M. H.; Beressi, JP; Rain, J. D.

doi:10.1530/eje.0.1420605

Cited by 22 publications

(21 citation statements)

References 34 publications

(25 reference statements)

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“…The various studies done to evaluate the ordering pattern of thyroid function tests indicate that frequency of order of TFT is much higher than that of only TSH [11][12][13]. Similar studies have not been reported from India.…”

Section: Introductionmentioning

confidence: 87%

Are we using Thyroid Function Tests Appropriately?

et al. 2011

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Thyroid function tests are very important for the diagnosis and monitoring of patients with thyroid dysfunction. The guidelines recommend serum thyroid stimulating hormone (TSH) as the single most reliable test to diagnose all common forms of hypothyroidism and hyperthyroidism. The aim of this study was to analyze the ordering pattern for thyroid function tests by physicians and the analysis of results based on the clinical history. The mean age of the patients was 32.5 ± 6.5 years. Majority of samples (87.7% of total) were received from the departments of Medicine and Gynae. Thyroid profiles (47.5%) were ordered more frequently as compared to TSH only (46%). There was no significant difference in the percentage of normal reports for both types of tests. 77.8% of TFT and 76.6% of TSH samples had results within the reference range. The percentage of abnormal results was 13.7% in the patients who were screened for thyroid disorders. There is a need to redefine the case definition for thyroid dysfunction and order the appropriate test in a rational and cost effective manner.

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Section: Introductionmentioning

confidence: 87%

Are we using Thyroid Function Tests Appropriately?

et al. 2011

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“…The resources needed to perpetuate educational strategies (i.e., lectures or individual teaching sessions) are significant and probably need to be continuous to maintain an effect, especially in teaching hospitals where ordering physicians are constantly changing. Even in studies where the educational strategy was low effort (i.e., the distribution of a guideline), multiple reminders and repeated meetings were necessary to maintain the change in behavior [89,97,106,111]. There was only one purely educational intervention that reported results from > 1 year after the intervention began but this study did not use time series analysis to determine if utilization returned to baseline during this time [70].…”

Section: Sustainabilitymentioning

confidence: 99%

Influence of educational, audit and feedback, system based, and incentive and penalty interventions to reduce laboratory test utilization: a systematic review

Kobewka¹,

Ronksley

McKay

et al. 2015

Clinical Chemistry and Laboratory Medicine (CCLM)

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Laboratory and radiographic tests are often ordered unnecessarily. This excess testing has financial costs and is a burden on patients. We performed a systematic review to determine the effectiveness interventions to reduce test utilization by physicians. The MEDLINE and EMBASE databases were searched for the years 1946 through to September 2013 for English articles that had themes of test utilization and cost containment or optimization. Bibliographies of included papers were scanned to identify other potentially relevant studies. Our search resulted in 3236 articles of which 109 met the inclusion criteria of having an intervention aimed at reducing test utilization with results that could be expressed as a percent reduction in test use relative to the comparator. Each intervention was categorized into one or more non-exclusive category of education, audit and feedback, system based, or incentive or penalty. A rating of study quality was also performed. The percent reductions in test use ranged from a 99.7% reduction to a 27.7% increase in test use. Each category of intervention was effective in reducing test utilization. Heterogeneity between interventions, poor study quality, and limited time horizons makes generalizations difficult and calls into question the validity of results. Very few studies measure any patient safety or quality of care outcomes affected by reduced test use. There are numerous studies that use low investment strategies to reduce test utilization with one time changes in the ordering system. These low investment strategies are the most promising for achievable and durable reductions in inappropriate test use.

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“…Although the universal antithyroid antibodies testing during pregnancy has been published to be cost effective (19), its routine implementation in certain clinical settings (clinics, private practice) might not be appropriate in either economic or practical terms (45).…”

Section: Reasons Against Universal Screeningmentioning

confidence: 99%

Identifying and treating subclinical thyroid dysfunction in pregnancy: emerging controversies

Velasco

Taylor

2018

European Journal of Endocrinology

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Thyroid hormones are essential for an adequate growth and development of the fetus. In addition to the classical association between maternal hypothyroidism and neurological impairment in the progeny, other adverse reproductive events have been associated with maternal thyroid dysfunction including infertility, miscarriage and preterm delivery. Although all scientific societies endorse the treatment of overt hypothyroidism; the management and/or treatment of subclinical hypothyroidism, hypothyroxinemia or antithyroid antibody-positive women should be considered with caution. Important trials have found no clear benefit of treatment of subclinical hypothyroidism in terms of cognitive outcomes; however, other interventional studies appear to reduce some of the obstetric and perinatal complications. As a result, the dilemma between universal screening or selective screening of women at high risk of thyroid dysfunction during pregnancy remains unresolved. Despite this, levothyroxine is also now regularly prescribed by gynaecologists and centres for reproductive medicine. In this context, there is increasing concern regarding the risk of over diagnosis and subsequent potential overtreatment. Taken together, we need to reconsider how thyroid dysfunction should be identified in pregnant women and highlight the arguments for and against the use of levothyroxine in obstetric practices. Our main findings: the mismatch between the guidelines recommendations and the use of LT4 in clinical settings as well as the disparity of criteria between scientific societies from different medical specialties. In conclusion, it is essential to reach agreements between both endocrinologists and obstetricians.

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From guidelines to hospital practice: reducing inappropriate ordering of thyroid hormone and antibody tests

Cited by 22 publications

References 34 publications

Are we using Thyroid Function Tests Appropriately?

Are we using Thyroid Function Tests Appropriately?

Influence of educational, audit and feedback, system based, and incentive and penalty interventions to reduce laboratory test utilization: a systematic review

Identifying and treating subclinical thyroid dysfunction in pregnancy: emerging controversies

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