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Variability in thyroid function test requests across general practices in south-west England
Bijay Vaidya1, Obioha C Ukoumunne, Joanna Shuttleworth
1Department of Endocrinology, Royal Devon & Exeter Hospital, Exeter, UK. b.vaidya@exeter.ac.uk
Quality in Primary Care
|August 24, 2013
Summary
Thyroid function test (TFT) requests vary significantly between UK general practices. This study highlights the need to reduce unnecessary testing and standardize clinical practice for thyroid function tests.
Area of Science:
- Endocrinology
- Clinical Practice Research
Background:
- Thyroid function tests (TFTs) have seen a significant increase in utilization globally.
- Inconsistent clinical practices and inappropriate test requests are suspected drivers of this rise.
Purpose of the Study:
- To investigate the degree of variation in thyroid function test requests originating from general practices.
- To identify potential areas for optimizing diagnostic test utilization in primary care.
Main Methods:
- Analysis of routine data for all TFTs performed on patients aged 16 and over in two hospitals during 2010.
- Inclusion of data from 107 general practices requesting the tests.
Main Results:
- A total of 195,309 TFT requests were analyzed, with thyroid-stimulating hormone (TSH) being the most frequent test.
- Significant variation in TSH test requests per 1000 list size was observed across general practices, ranging from 84 to 482.
- Practice heterogeneity accounted for most of the variation, with hypothyroidism prevalence and socioeconomic deprivation explaining only 24% of the differences.
Conclusions:
- Wide variability exists in thyroid function test ordering among general practices.
- There is a clear opportunity to reduce both unnecessary TFTs and practice variation.
- Further research is needed to elucidate the underlying causes of this testing variability.
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