title: Exploring reasons for variation in ordering thyroid function tests in primary care: a qualitative study.
abstract: BACKGROUND
  The ordering of thyroid function tests (TFTs) is increasing but there is not a similar increase in thyroid disorders in the general population, leading some to query whether inappropriate testing is taking place. Inconsistent clinical practice is thought to be a cause of this, but there is little evidence of the views of general practitioners, practice nurses or practice managers on the reasons for variation in the ordering of TFTs.
  
  
  OBJECTIVE
  To find out the reasons for variation in ordering of TFTs from the perspective of primary healthcare professionals Methods: Fifteen semi-structured interviews were carried out with primary healthcare professionals (general practitioners, practice nurses, practice managers) that used one laboratory of a general hospital in South West England for TFTs. Framework Analysis was used to analyse views on test ordering variation at the societal, practice, individual practitioner and patient level.
  
  
  RESULTS
  A number of reasons for variation in ordering across practices were suggested. These related to: primary healthcare professionals awareness of and adherence to national policy changes; practices having different protocols on TFTs ordering; the set-up and use of computer systems in practices; the range of practice healthcare professionals able to order TFTs; greater risk-aversion amongst general practitioners and changes in their training and finally how primary healthcare staff responded to patients who were perceived to seek help more readily than in the past.
  
  
  CONCLUSIONS
  The reasons for variation in TFTs ordering are complex and interdependent. Interventions to reduce variation in TFTs ordering need to consider multiple behavioural and contextual factors to be most effective.
authors.affiliation: University of Exeter Medical School, Veysey Building, Salmon Pool Lane, Exeter, EX2 4SG, UK. r.j.l.hardwick@exeter.ac.uk.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hardwick
authors.affiliation: Research Fellow, BA (Hons), PhD. NIHR CLAHRC South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, UK.
authors.forename: Janet
authors.initials: J
authors.lastname: Heaton
authors.affiliation: University of Exeter Medical School, University of Exeter, Exeter, UK.
authors.forename: Glyn
authors.initials: G
authors.lastname: Griffiths
authors.affiliation: Department of Endocrinology, Royal Devon and Exeter Hospital, Exeter, UK.
authors.forename: Bijay
authors.initials: B
authors.lastname: Vaidya
authors.affiliation: Plymouth University Peninsula Schools of Medicine and Dentistry, ITTC Building, Tamar Science Park, Plymouth, UK.
authors.forename: Sue
authors.initials: S
authors.lastname: Child
authors.affiliation: Royal Cornwall Hospital, Truro, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Fleming
authors.affiliation: University of Exeter Medical School, University of Exeter, Exeter, UK.
authors.forename: William Trevor
authors.initials: WT
authors.lastname: Hamilton
authors.affiliation: Pool Health Centre, Redruth, Cornwall, UK.
authors.forename: Julie
authors.initials: J
authors.lastname: Tomlinson
authors.affiliation: University of Exeter Medical School, University of Exeter, Exeter, UK.
authors.forename: Zhivko
authors.initials: Z
authors.lastname: Zhelev
authors.affiliation: Royal Cornwall Hospital, Truro, UK.
authors.forename: Anthea
authors.initials: A
authors.lastname: Patterson
authors.affiliation: MBBS Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Hyde