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Exploring reasons for variation in ordering thyroid function tests in primary care: a qualitative study.

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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.

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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.