{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:46:29Z","timestamp":1772066789849,"version":"3.50.1"},"reference-count":31,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2021,3,28]],"date-time":"2021-03-28T00:00:00Z","timestamp":1616889600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Clinical Practice"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Thyroid\u2010stimulating hormone (TSH) is a common test used to detect and monitor clinically significant hypo\u2010 and hyperthyroidism. Population\u2010based screening of asymptomatic adults for thyroid disorders is not recommended.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>The research objectives were to determine patterns of TSH testing in Canadian and English primary care practices, as well as patient and physician practice characteristics associated with testing TSH for primary care patients with no identifiable indication.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this 2\u2010year cross\u2010sectional observational study, Canadian and English electronic medical record databases were used to identify patients and physician practices. Cohorts of patients aged 18\u00a0years or older, without identifiable indications for TSH testing, were generated from these databases. Analyses were performed using a random\u2010effects logistic regression to determine patient and physician practice characteristics associated with increased testing. We determined the proportion of TSH tests performed concurrently with at least one common screening blood test (lipid profile or hemoglobin A1c). Standardised proportions of TSH test per family practice were used to examine the heterogeneity in the populations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>At least one TSH test was performed in 35.97% (N\u00a0=\u00a0489\u00a0663) of Canadian patients and 29.36% (N\u00a0=\u00a01\u00a0030\u00a0489) of English patients. Almost all TSH tests in Canada and England (95.69% and 99.23% respectively) were within the normal range (0.40\u20105.00\u00a0mU\/L). A greater number of patient\u2010physician encounters was the strongest predictor of TSH testing. It was determined that 51.40% of TSH tests in Canada and 76.55% in England were performed on the same day as at least one other screening blood test. There was no association between the practice size and proportion of asymptomatic patients tested.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This comparative binational study found TSH patterns suggestive of over\u2010testing and potentially thyroid disorder screening in both countries. There may be significant opportunities to improve the appropriateness of TSH ordering in Canada and England and therefore improve the allocation of limited system resources.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ijcp.14144","type":"journal-article","created":{"date-parts":[[2021,3,18]],"date-time":"2021-03-18T08:12:24Z","timestamp":1616055144000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Over\u2010use of thyroid testing in Canadian and UK primary care in frequent attenders: A cross\u2010sectional study"],"prefix":"10.1155","volume":"75","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6202-3895","authenticated-orcid":false,"given":"Noah","family":"Crampton","sequence":"first","affiliation":[{"name":"Faculty of Medicine Department of Family and Community Medicine University of Toronto Toronto ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sumeet","family":"Kalia","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Department of Family and Community Medicine University of Toronto Toronto ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Elisabeth","family":"Del Giudice","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Department of Family and Community Medicine University of Toronto Toronto ON Canada"},{"name":"Department of Family and Community Medicine Sunnybrook Health Sciences Centre Toronto ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kimberly","family":"Wintemute","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Department of Family and Community Medicine University of Toronto Toronto ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Sullivan","sequence":"additional","affiliation":[{"name":"North York Family Health Team Toronto ON Canada"},{"name":"University of St Andrews Bute Medical School St Andrews UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Babak","family":"Aliarzadeh","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Department of Family and Community Medicine University of Toronto Toronto ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Meaney","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Department of Family and Community Medicine University of Toronto Toronto ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rahim","family":"Moineddin","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Department of Family and Community Medicine University of Toronto Toronto ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Singer","sequence":"additional","affiliation":[{"name":"University of Manitoba Winnipeg MB Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William","family":"Hinton","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences University of Oxford Oxford UK"},{"name":"Department of Clinical and Experimental Medicine University of Surrey Guildford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julian","family":"Sherlock","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences University of Oxford Oxford UK"},{"name":"Department of Clinical and Experimental Medicine University of Surrey Guildford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Williams","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences University of Oxford Oxford UK"},{"name":"Department of Clinical and Experimental Medicine University of Surrey Guildford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"de Lusignan","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences University of Oxford Oxford UK"},{"name":"Royal College of General Practitioners Research and Surveillance Centre London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle","family":"Greiver","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Department of Family and Community Medicine University of Toronto Toronto ON Canada"},{"name":"North York General Hospital Toronto ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,3,28]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"Getting a Diagnosis and Starting Treatment.2020.http:\/\/www.thyroiduk.org.uk\/tuk\/diagnosis\/getting_diagnosis.html. Accessed March 11 2020."},{"key":"e_1_2_9_3_1","unstructured":"SneeA.Painful proof that one thyroid test does not fit all. The Telegraph.2014."},{"key":"e_1_2_9_4_1","volume-title":"Harrison's Principles of Internal Medicine","author":"Jameson JL","year":"2018"},{"key":"e_1_2_9_5_1","volume-title":"Screening for and Treatment of Thyroid Dysfunction","author":"Bruin RJ","year":"2014"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.7326\/M15-0483"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.190395"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.1995.tb01894.x"},{"key":"e_1_2_9_9_1","unstructured":"Family medicine | Choosing Wisely Canada: Choosing Wisely Canada;2014.http:\/\/www.choosingwiselycanada.org\/recommendations\/family\u2010medicine\/. Accessed March 11 2020."},{"key":"e_1_2_9_10_1","unstructured":"Recommendations | Thyroid disease: assessment and management | Guidance | NICE: NICE;2019.https:\/\/www.nice.org.uk\/guidance\/ng145\/chapter\/Recommendations. Accessed March 11 2020."},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ecl.2007.04.003"},{"key":"e_1_2_9_12_1","volume-title":"Patterns of Health Care in Ontario: The ICES Practice Atlas","author":"Anderson G","year":"1996"},{"key":"e_1_2_9_13_1","unstructured":"Infobulletin 10030\u2010 amendments to Laboratory Requisition Form #4422\u201084 Toronto: Ministry of Health and Long Term Care of Ontario;2012.http:\/\/www.health.gov.on.ca\/en\/pro\/programs\/ohip\/bulletins\/10000\/bul10030.pdf. Accessed March 11 2020."},{"key":"e_1_2_9_14_1","first-page":"143","article-title":"Variability in thyroid function test requests across general practices in south\u2010west England","volume":"21","author":"Vaidya B","year":"2013","journal-title":"Qual Prim Care"},{"key":"e_1_2_9_15_1","first-page":"e389","article-title":"Use of thyroid\u2010stimulating hormone tests for identifying primary hypothyroidism in family medicine patients","volume":"63","author":"Birk\u2010Urovitz E","year":"2017","journal-title":"Can Fam Physician"},{"key":"e_1_2_9_16_1","first-page":"e487","article-title":"Choosing Wisely Canada campaign associated with less overuse of thyroid testing: Retrospective parallel cohort study","volume":"65","author":"Wintemute K","year":"2019","journal-title":"Can Fam Phys"},{"key":"e_1_2_9_17_1","unstructured":"Canada: International Health Care System Profiles;2020.https:\/\/international.commonwealthfund.org\/countries\/canada\/. 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Accessed March 11 2020."},{"key":"e_1_2_9_25_1","first-page":"e1082","article-title":"2018 AHA\/ACC\/AACVPR\/AAPA\/ABC\/ACPM\/ADA\/AGS\/APhA\/ASPC\/NLA\/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines","volume":"139","author":"Grundy Scott M","year":"2019","journal-title":"Circulation"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc14-S014"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2013-2409"},{"key":"e_1_2_9_28_1","first-page":"256","article-title":"Exploring reasons for variation in ordering thyroid function tests in primary care: a qualitative study","volume":"22","author":"Hardwick R","year":"2014","journal-title":"Qual Prim Care"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000441-195711000-00018"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-010065"},{"key":"e_1_2_9_31_1","first-page":"824","article-title":"Periodic preventive health visits: a more appropriate approach to delivering preventive services","volume":"63","author":"Birtwhistle R","year":"2017","journal-title":"Can Fam Phys"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0035-1559782"}],"container-title":["International Journal of Clinical Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ijcp.14144","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ijcp.14144","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ijcp.14144","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,12]],"date-time":"2024-09-12T14:52:25Z","timestamp":1726152745000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ijcp.14144"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,28]]},"references-count":31,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2021,6]]}},"alternative-id":["10.1111\/ijcp.14144"],"URL":"https:\/\/doi.org\/10.1111\/ijcp.14144","archive":["Portico"],"relation":{},"ISSN":["1368-5031"],"issn-type":[{"value":"1368-5031","type":"print"}],"subject":[],"published":{"date-parts":[[2021,3,28]]},"assertion":[{"value":"2020-05-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-03-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-03-28","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e14144"}}