Thyroid function testing in eastern Nepal and the impact of CME on subsequent requests

Area of Science:

• Clinical Chemistry
• Endocrinology
• Health Services Research

Background:

• Thyroid function tests (TFT) are crucial diagnostic tools.
• The introduction of TFT in eastern Nepal's BPKIHS highlighted challenges in rational test ordering.
• Evaluating the appropriateness of diagnostic test requests is essential for healthcare efficiency.

Purpose of the Study:

• To assess the rationality of thyroid function test (TFT) ordering by medical practitioners in eastern Nepal.
• To determine the potential cost savings achievable through rational TFT use.
• To evaluate the impact of continuing medical education (CME) on TFT ordering patterns.

Main Methods:

• Retrospective analysis of 1 year of TFT requests at BPKIHS.
• Evaluation of TFT advice against established textbook algorithms.
• Assessment of cost reduction potential and impact on patient management.
• Analysis of CME effectiveness on subsequent TFT advising.

Main Results:

• Only approximately 14% of TFT requests followed rational diagnostic strategies.
• Rational TFT advice could have reduced investigation costs by 43.11%.
• Patient management and disease outcomes were not compromised by rationalized testing.
• CME lectures significantly improved the quality of TFT advising patterns.

Conclusions:

• There is a significant need for strategic approaches and improved medical education when introducing costly laboratory tests like TFT.
• Rationalizing diagnostic test ordering can lead to substantial cost savings in healthcare.
• Continuing medical education is a vital tool for enhancing the appropriate use of diagnostic tests.