Developing a Score to Grade Primary Care Providers’ Potentially Inappropriate Thyroid-Stimulating Hormone Testing Behaviour in Nova Scotia

Abstract

Introduction: Primary care providers are gatekeepers, and they only open the ‘gate’ for sick patients to further care and testing. Blood work is potentially overused, and overtesting can worsen health outcomes. We will use the common Thyroid-Stimulating Hormone (TSH) test as an example for the study. Objectives: Describe primary care providers’ TSH testing behaviour in Nova Scotia from 2014 to 2018 and develop a method to identify potentially inappropriate testing (PIT). Methods: Retrospective primary care electronic medical records from MaRNet-FP will be used to identify PITs and calculate PIT scores for participating physicians and nurse practitioners. Findings: Almost 9 % of TSH tests were potentially inappropriate in 2018 on average per provider. Most providers had a low PIT score, but 7 % are potentially overtesting their patients with TSH at a high rate. We did not find any changes in the frequency of laboratory orders or visits after a PIT.