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Barriers and facilitators to reducing overuse of thyroid function testing: a mixed-methods study.

Annabel Jane Chapman1, Aneesa Khan2, Jordyn Thompson2

  • 1Department of Anesthesiology, Pharmacology and Therapeutics, Therapeutics Initiative, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada.

BMJ Quality & Safety
|October 5, 2025
PubMed
Summary
This summary is machine-generated.

Overuse of thyroid function tests stems from patient expectations, knowledge gaps, and system issues. Interventions should focus on education, feedback, and improved lab ordering processes to promote appropriate testing.

Keywords:
Clinical practice guidelinesGeneral practiceHealth services researchHealthcare quality improvementLaboratory medicine

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Area of Science:

  • Endocrinology
  • Health Services Research
  • Implementation Science

Background:

  • Thyroid function laboratory testing is frequently overused.
  • Understanding barriers and facilitators is crucial for developing effective de-implementation strategies.

Purpose of the Study:

  • To explore barriers and facilitators to appropriate thyroid function testing.
  • To inform the development of tailored de-implementation interventions.

Main Methods:

  • Mixed-methods study using surveys and focus groups in British Columbia, Canada (June-October 2023).
  • Quantitative data analyzed with descriptive statistics.
  • Qualitative data analyzed using summative content analysis and thematic analysis.
  • Framework used: Combined Theoretical Domains Framework and Capability, Opportunity, Motivation-Behaviour model.

Main Results:

  • Barriers identified: patient expectations (symptoms, internet searches, alternate providers), practitioner knowledge gaps (test interpretation, screening frequency), and health system factors (time, provider availability, existing processes).
  • Facilitators identified: educational resources (practitioner and patient), improved health information systems, reflexive testing, and personalized feedback.
  • Survey response rate was 1.4% (230 practitioners); 53 practitioners participated in six focus groups.

Conclusions:

  • Interventions should integrate accessible physician education and feedback, patient materials, and optimized laboratory ordering systems.
  • Future research should focus on developing and evaluating these intervention components in British Columbia.