{
  "abstract": "Objectives Thyroid function tests (TFTs) are frequently overused in laboratory practice. Current clinical practice guidelines recommend more selective testing of free T3 and free T4 hormones without proper indication and advise against routine TSH (Thyroid-stimulating hormone) testing in patients with known hypothyroidism.Our systematic review update aims to summarise the effectiveness of behaviour change interventions that target the reduction of low-value TFT ordering in clinical practice. It explores the theoretical foundations and contextual factors considered in the development of these interventions. By identifying strategies to reduce unnecessary testing, the review seeks to improve resource utilisation, enhance patient care, and align practice with evidence-based guidelines.Method Our update builds on a review conducted in 2016 by Zhelev et al.1 We performed a comprehensive search of Medline, Embase, Scopus, and the Cochrane Library for randomised controlled trials (RCTs ), non-randomised controlled studies, and before-and-after studies. We included literature up to July 7th, 2024 . Due to the heterogeneity of studies, we clustered interventions into soft or structural. Structural interventions are those that directly influence physicians at the point of care, such as changes in funding and clinical decision support systems (CDSS). Soft interventions provide information or guidance outside the immediate care setting, including reminders, education, guidelines/protocols, and audit/feedback. Outcomes were grouped into volume reduction (test rates, expenditure) and improvement of care (appropriateness, shift in ordering pattern, coefficient of variation among physicians). We used relative change as the standardised outcome metric, and applied the GRADE approach to assess the certainty of evidence.Results We screened 2,782 records and identified 21 new studies since 2016. In total, 47 studies (54 interventions, including five RCTs) met the eligibility criteria. While the previous review found soft interventions most common, 1 our update revealed that most recent studies introduced structural interventions. CDSS were the most common type of TFT intervention (n=28). The most common CDSS interventions involved order form changes (n=12), alerts (n=8), and reflex testing with automatic discharge (n=7). Nearly all interventions reported a reduction in low-value TFT ordering (n=52), with very low to moderate certainty of evidence. Among 49 interventions assessing volume reduction, only two reported increased test rates. All 24 studies that measured improvement of care indicated positive developments. Based on the GRADE profiles, RCT evidence showed similar results for structural and soft interventions, while observational evidence suggests a higher success rate for structural interventions. Reporting on theoretical foundations or contextual factors remained scarce. Conclusions Evidence on de-implementation strategies for TFT ordering suggests that behaviour change interventions can significantly reduce the overuse of thyroid function testing. Structural interventions, especially CDSS, were the most effective. Though the interventions show consistently positive results, the limited quality of evidence highlights the need for more high-quality studies to support meaningful changes in clinical practice. Future interventions should include cost-effectiveness analyses and incorporate theoretical frameworks to ensure reproducibility and facilitate implementation in routine care. Our findings can help guide the development of effective, targeted interventions to reduce low-value TFT ordering across various levels, from regional and practice-based settings to national initiatives.Reference Zhelev Z, Abbott R, Rogers M, et al. Effectiveness of interventions to reduce ordering of thyroid function tests: a systematic review. BMJ open. 2016;6(6):e010065. doi:10.1136/bmjopen-2015-010065.",
  "authors": [
    {
      "affiliations": [
        "Technical University Berlin, Berlin, Germany",
        "Jena University Hospital, Jena, Germany"
      ],
      "name": "Meik Hildebrandt"
    },
    {
      "affiliations": [
        "Technical University Berlin, Berlin, Germany"
      ],
      "name": "Carolina Pioch"
    },
    {
      "affiliations": [
        "HTA Austria – Austrian Institute for Health Technology Assessment GmbH, Vienna, Austria",
        "Technical University Berlin, Berlin, Germany"
      ],
      "name": "Gregor Goetz"
    },
    {
      "affiliations": [
        "Jena University Hospital, Jena, Germany"
      ],
      "name": "Verena Vogt"
    }
  ],
  "title": "019 Effectiveness of interventions to reduce low-value thyroid function tests: an update of a systematic review",
  "uid": "cca48504-808d-5278-bb27-f81999017e63"
}