Effectiveness and mechanisms of interventions to reduce low-value thyroid function tests: a systematic review

Area of Science:

• Health Services Research
• Clinical Practice Improvement
• Behavioral Science in Medicine

Background:

• Thyroid function tests are frequently overused in clinical practice.
• Low-value testing contributes to healthcare costs and potential patient harm.
• Effective strategies are needed to optimize thyroid test ordering.

Purpose of the Study:

• To systematically review behavior change interventions aimed at reducing low-value thyroid testing.
• To identify theoretical underpinnings and contextual factors influencing intervention success.
• To assess the effectiveness of different intervention types.

Main Methods:

• Comprehensive systematic search of multiple databases (Medline, Embase, Scopus, Cochrane Library).
• Inclusion of randomized and non-randomized controlled trials, and before-and-after studies.
• Categorization of interventions into 'soft' (education, feedback) and 'structural' (decision support systems, funding changes).
• PRISMA guidelines followed, with critical appraisal and GRADE certainty assessment.

Main Results:

• 47 studies (54 interventions) were included; 5 were randomized trials.
• Structural interventions, particularly clinical decision support systems, were most common and effective.
• Most interventions (52/54) reduced low-value thyroid testing, often by ≥20%, but evidence certainty was low to moderate.
• Positive impacts on care quality were observed in 24 studies.
• Few interventions referenced theoretical foundations or contextual factors.

Conclusions:

• Structural interventions, especially clinical decision support systems, are most effective for reducing thyroid testing.
• While positive effects are common, the evidence base requires strengthening with high-quality studies.
• Findings can inform targeted strategies to reduce low-value thyroid testing at various healthcare levels.