减少低值甲状腺功能测试的干预措施的有效性和机制:系统性审查
Carolina Pioch1, Meik Hildebrandt2,3, Gregor Goetz4
1Department of Health Care Management, Technical University of Berlin, Berlin, Germany. c.pioch@tu-berlin.de.
Systematic reviews
|February 26, 2026
概括
行为干预有效地减少了低价值的甲状腺检测,像临床决策支持系统这样的结构性变化显示出最有前途的结果. 需要更多高质量的研究来证实这些发现,并指导实践的变化.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 改善临床实践的改善
- 医学中的行为科学.
背景情况:
- 甲状腺功能测试在临床实践中经常被过度使用.
- 低值检测有助于医疗保健成本和潜在的患者伤害.
- 需要有效的策略来优化甲状腺测试订单.
研究的目的:
- 系统地审查旨在减少低价值甲状腺检测的行为改变干预措施.
- 确定影响干预成功的理论基础和上下文因素.
- 评估不同类型干预措施的有效性.
主要方法:
- 在多个数据库 (Medline,Embase,Scopus,Cochrane Library) 中进行全面的系统搜索.
- 包括随机和非随机受控试验,以及前后研究.
- 干预措施分为"软" (教育,反) 和"结构性" (决策支持系统,资金变化) 的类别.
- 接下来是PRISMA指导方针,并进行了批判性评估和GRADE确定性评估.
主要成果:
- 包括47项研究 (54项干预),其中5项是随机试验.
- 结构性干预,特别是临床决策支持系统,是最常见和最有效的.
- 大多数干预措施 (52/54) 减少了低值的甲状腺检测,通常为≥20%,但证据确定性低至中等.
- 在24项研究中观察到对护理质量的积极影响.
- 很少有干预措施引用理论基础或上下文因素.
结论:
- 结构性干预,特别是临床决策支持系统,对于减少甲状腺检测最有效.
- 虽然积极影响很常见,但证据基础需要通过高质量的研究来加强.
- 这些发现可以为有针对性的策略提供信息,以减少各种医疗保健层面的低价值甲状腺检测.
相关概念视频
Synthesis and Regulation of Thyroid Hormones
8.4K
Low blood levels of the thyroid hormones — triiodothyronine (T3) and thyroxine (T4) — signal the hypothalamus to release the thyrotropin-releasing hormone (TRH). TRH then reaches the pituitary gland and stimulates the release of thyroid-stimulating hormone(TSH) into the bloodstream.
Upon reaching the thyroid gland, TSH stimulates the follicular cells' active uptake of iodide ions from the blood. The ions diffuse to the apical surface of the cells and are oxidized to iodine. The...
Upon reaching the thyroid gland, TSH stimulates the follicular cells' active uptake of iodide ions from the blood. The ions diffuse to the apical surface of the cells and are oxidized to iodine. The...
8.4K
Functions of Thyroid Hormones
6.0K
The thyroid hormone (TH) plays a pivotal role in the intricate orchestration of physiological processes, exerting profound effects on development, metabolism, and homeostasis throughout different life stages.
TH is indispensable for the normal development and maturation of the skeletal, muscular, and nervous systems during fetal and childhood growth. It facilitates bone mineral turnover and regulates protein synthesis in developing tissues, contributing significantly to overall growth and...
TH is indispensable for the normal development and maturation of the skeletal, muscular, and nervous systems during fetal and childhood growth. It facilitates bone mineral turnover and regulates protein synthesis in developing tissues, contributing significantly to overall growth and...
6.0K
Therapeutic Drug Monitoring: Affecting Factors
288
Therapeutic Drug Monitoring (TDM) is the clinical practice of measuring specific drug levels in a patient's blood or body tissues to manage and optimize therapy. TDM is crucial for drugs with narrow therapeutic windows, like warfarin and phenytoin, where incorrect doses can lead to treatment failure or severe side effects. This monitoring ensures the dosage administered is within a safe and effective range. The factors affecting therapeutic drug monitoring include:Patient-Specific Factors:a.
288
Therapeutic Drug Monitoring: Drug Analysis Methods
250
Therapeutic Drug Monitoring (TDM) is a clinical practice that measures specific drug levels in a patient's blood or body tissues to tailor drug therapy effectively. This monitoring is critical for managing drugs with narrow therapeutic indices like digoxin and phenytoin, ensuring they are both safe and effective. For instance, monitoring theophylline levels in asthma patients involves precision and sensitivity to adjust doses according to individual responses to therapy, ensuring efficacy and...
250
Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
244
In clinical practice, the direct measurement of hepatic blood flow to evaluate liver function presents significant challenges due to the intricate and specialized nature of the necessary techniques. Consequently, healthcare professionals often rely on empirical estimates derived from thorough patient examinations and liver function tests to gauge liver health. Among the tools at their disposal, the Child–Pugh and MELD scoring systems stand out for their ability to categorize and assess...
244
Therapeutic Drug Monitoring: Overview and Classification
445
Therapeutic Drug Monitoring (TDM) is a clinical practice that measures specific drug levels in a patient's blood at designated intervals to ensure the drug concentration stays within a therapeutic range. This monitoring is crucial for optimizing individual dosage regimens, enhancing therapeutic efficacy, and minimizing drug-related toxicity. TDM is vital for drugs with narrow therapeutic windows, significant variability in pharmacokinetics, and a clear correlation between plasma levels and...
445
