Effectiveness of interventions to reduce ordering of thyroid function tests: a systematic review.
To evaluate the effectiveness of behaviour changing interventions targeting ordering of thyroid function tests.



Systematic review.



MEDLINE, EMBASE and the Cochrane Database up to May 2015.



We included studies evaluating the effectiveness of behaviour change interventions aiming to reduce ordering of thyroid function tests. Randomised controlled trials (RCTs), non-randomised controlled studies and before and after studies were included. There were no language restrictions.



2 reviewers independently screened all records identified by the electronic searches and reviewed the full text of any deemed potentially relevant. Study details were extracted from the included papers and their methodological quality assessed independently using a validated tool. Disagreements were resolved through discussion and arbitration by a third reviewer. Meta-analysis was not used.



27 studies (28 papers) were included. They evaluated a range of interventions including guidelines/protocols, changes to funding policy, education, decision aids, reminders and audit/feedback; often intervention types were combined. The most common outcome measured was the rate of test ordering, but the effect on appropriateness, test ordering patterns and cost were also measured. 4 studies were RCTs. The majority of the studies were of poor or moderate methodological quality. The interventions were variable and poorly reported. Only 4 studies reported unsuccessful interventions but there was no clear pattern to link effect and intervention type or other characteristics.



The results suggest that behaviour change interventions are effective particularly in reducing the volume of thyroid function tests. However, due to the poor methodological quality and reporting of the studies, the likely presence of publication bias and the questionable relevance of some interventions to current day practice, we are unable to draw strong conclusions or recommend the implementation of specific intervention types. Further research is thus justified.



CRD42014006192.
NIHR CLAHRC South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, Devon, UK.
Zhivko
0000-0002-0106-2401
Z
Zhelev
NIHR CLAHRC South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, Devon, UK.
Rebecca
R
Abbott
NIHR CLAHRC South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, Devon, UK.
Morwenna
M
Rogers
Clinical Chemistry, Royal Cornwall Hospital, Treliske, Truro, UK.
Simon
S
Fleming
Clinical Chemistry, Royal Cornwall Hospital, Treliske, Truro, UK.
Anthea
A
Patterson
NIHR CLAHRC South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, Devon, UK.
William Trevor
WT
Hamilton
NIHR CLAHRC South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, Devon, UK.
Janet
J
Heaton
NIHR CLAHRC South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, Devon, UK.
Jo
0000-0002-5161-0234
J
Thompson Coon
Department of Endocrinology, Royal Devon and Exeter Hospital, Exeter, UK.
Bijay
B
Vaidya
Exeter Test Group, Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK.
Christopher
C
Hyde
D003362:Cost-Benefit Analysis; D055317:Evidence-Based Practice; D019983:Guideline Adherence; D006295:Health Resources; D006801:Humans; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic; D013959:Thyroid Diseases / Q000175:diagnosis*; D013960:Thyroid Function Tests / Q000706:statistics & numerical data; D019564:Unnecessary Procedures
behaviour changing interventions; medical tests; systematic review; test ordering; thyroid function tests