A Question of Quality Improvement

1. 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.

2. 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

3. 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

4. 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