title: Reducing the number of T3 orders in the Paris hospital network: towards better appropriatness of thyroid function test prescription.
abstract: In vitro thyroid function tests are among the most frequently prescribed laboratory procedures. Serum triiodothyronine (T3) tests are seldom necessary as a first-level measurement. Our objectives were to measure the proportion of T3 measurements relative to all in vitro thyroid function tests in a large hospital network and to investigate the contributions of various interventions to change prescribers'behavior. We performed two cross-sectional surveys in 1995 and 1998 in the 50 Paris University hospitals. Questionnaires were mailed to the heads of the 30 laboratories performing thyroid function tests. One-month orders of free and total thyroxine, free and total T3 and thyrotropin were recorded; changes in T3 measurement orders between the two periods were estimated and association with interventions were expressed as odds ratios and 95% confidence intervals. Twenty-five heads of laboratory responded to both surveys. In 1995, T3 measurements constituted 21% of in vitro thyroid function test ordering, which seems to us exceedingly high. The decrease in T3 measurement ordering observed in 1998 (15% of thyroid function test ordering) was independently associated with multiple behavioral changes: educational interventions, structured test form use and year of prescription.
authors.affiliation: Département de santé publique, CHU Cochin-Port Royal, AP-HP-Université René Descartes-Paris V, 24 rue du faubourg Saint-Jacques, 75014 Paris. gwenaelle.Vidal-Trecan@cochin.univ-paris5.fr
authors.forename: G
authors.initials: G
authors.lastname: Vidal-Trécan
authors.forename: M-E
authors.initials: ME
authors.lastname: Toubert
authors.forename: J
authors.initials: J
authors.lastname: Coste
authors.forename: F
authors.initials: F
authors.lastname: Paycha
authors.forename: I
authors.initials: I
authors.lastname: Durand-Zaleski
authors.forename: Y
authors.initials: Y
authors.lastname: Fulla
authors.forename: A
authors.initials: A
authors.lastname: Abella
authors.forename: R
authors.initials: R
authors.lastname: Fior
authors.forename: P
authors.initials: P
authors.lastname: Georges
mesh_terms: D006801:Humans; D007755:Laboratories, Hospital / Q000458:organization & administration; D010297:Paris; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D013960:Thyroid Function Tests / Q000706:statistics & numerical data*; D014284:Triiodothyronine / Q000097:blood*
chemical_list: D014284:Triiodothyronine