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This study investigates TSH testing practices in pregnancy at a family practice center, focusing on physician perspectives and testing frequency. The research identified major themes influencing TSH testing behaviors and implications for clinical practice. Adherence to recent guidelines can reduce overdiagnosis, overtreatment, false positives, and mitigate psychological effects of labeling. This quality improvement initiative aims to enhance patient care and optimize healthcare resources.
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A Question of Quality Improvement • In response to Guideline recommendations from the ATA either recommending against universal screening in pregnancy (2012) or providing no recommendation for or against screening (2017), due to insufficient evidence • Identify if TSH over testing for pregnant patients without thyroiddisease is present at our family practice centre • Explore the perspective of frequent testers; understand TSH testing by physicians at our family practice centre.
What the Researchers Did • Quantitative analysis of TSH testing done at a Canadian Family Practice Clinic • Focusing on physicians with high TSH ordering frequency • Qualitative deductive analysis exploring the perspectives of physicians’ most frequently prescribing the test • Major themes identified
What the Researchers Found • In 2016, 411 unique pregnant women at the clinic were sent for TSH testing; 200 of these tests were requested by 28 staff physicians • In terms of highest TSH testing frequency, six family physicians ordered between 10 and 48 tests. • Major Themes to explain or justify screening for subclinical hypothyroidism in pregnancy include: Clinical uncertainty, prior education, cognitive bias, openness to change, guideline directed, and lack of urgency to change
What This Means for Clinical Practice • Adherence to most recent findings • Reduction of over diagnosis and overtreatment • Reduction in false positive results • Avoiding psychological effects of labelling • Cost/Savings
