Reducing the number of T3 orders in the Paris hospital network: towards better appropriatness of thyroid function test prescription.
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.
Vidal-Trécan
G
G
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
Toubert
M-E
ME
Coste
J
J
Paycha
F
F
Durand-Zaleski
I
I
Fulla
Y
Y
Abella
A
A
Fior
R
R
Georges
P
P
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*
D014284:Triiodothyronine