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Exploring reasons for variation in ordering thyroid function tests in primary care: a qualitative study
Rebecca Hardwick1, Janet Heaton2, Glyn Griffiths3
1University of Exeter Medical School, Veysey Building, Salmon Pool Lane, Exeter, EX2 4SG, UK. r.j.l.hardwick@exeter.ac.uk.
Quality in Primary Care
|April 19, 2015
Summary
Variation in thyroid function test (TFT) ordering stems from complex factors including adherence to policy, practice protocols, and patient demand. Addressing this requires multifaceted interventions targeting behavioral and contextual elements.
Area of Science:
- Endocrinology
- Primary Healthcare
- Health Services Research
Background:
- Thyroid function test (TFT) ordering is rising without a corresponding increase in thyroid disorders, suggesting potential overuse.
- Inconsistent clinical practices are suspected as a cause, but primary care professionals' views on TFT ordering variations are under-researched.
Purpose of the Study:
- To investigate the reasons behind variations in ordering thyroid function tests (TFTs) from the perspective of primary healthcare professionals.
- To understand the factors influencing TFT ordering at societal, practice, individual practitioner, and patient levels.
Main Methods:
- Conducted fifteen semi-structured interviews with general practitioners, practice nurses, and practice managers.
- Employed Framework Analysis to examine views on test ordering variation.
Main Results:
- Identified multiple reasons for ordering variation, including awareness of national policy, differing practice protocols, and computer system configurations.
- Highlighted the impact of the range of professionals ordering tests, practitioner risk aversion, training changes, and patient-initiated help-seeking behaviors.
Conclusions:
- Variation in TFT ordering is complex and influenced by interdependent factors.
- Effective interventions must address a range of behavioral and contextual elements to reduce unnecessary testing.
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