Evidence map›Paper›PMID 31722930›Full record

ArticleCanadian family physician Medecin de famille canadien2019

Choosing Wisely Canada campaign associated with less overuse of thyroid testing: Retrospective parallel cohort study.

Kimberly Wintemute, Michelle Greiver, Warren McIsaac, M Elisabeth Del Giudice, Frank Sullivan, Babak Aliarzadeh, Sumeet Kalia, Chris Meaney, Rahim Moineddin, Alexander Singer

Abstract readEvaluation Study
PubMed Full text at PMC
In one paragraph

Article in Canadian family physician Medecin de famille canadien, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Pooled it
  2. Inappropriate use of clinical practices in Canada: a systematic review.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2022
    Pooled it
  3. Pooled it
  4. Article
  5. Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Kimberly WintemuteAssistant Professor in the Department of Family and Community Medicine at the University of Toronto in Ontario and a family physician on the North York Family Health Team in the Department of Family and Community Medicine at North York General Hospital.
Michelle GreiverAssociate Professor in the Department of Family and Community Medicine at the University of Toronto, a family physician on the North York Family Health Team, Gordon F. Cheesbrough Chair in Family and Community Medicine at North York General Hospital, and Adjunct Scientist with ICES. michelle.greiver@nygh.on.ca.
Warren McIsaacAssociate Professor in the Department of Family and Community Medicine at the University of Toronto and a family physician in the Ray D. Wolfe Department of Family Medicine for Sinai Health System.
M Elisabeth Del GiudiceAssistant Professor in the Department of Family and Community Medicine at the University of Toronto and at Sunnybrook Health Sciences Centre.
Frank SullivanProfessor of Primary Care Medicine and Director of Research in the School of Medicine at the University of St Andrews in Scotland.
Babak AliarzadehUTOPIAN (University of Toronto Practice-Based Research Network) Data Analytics Manager in the Department of Family and Community Medicine at the University of Toronto.
Sumeet KaliaUTOPIAN Data Analyst in the of Department of Family and Community Medicine at the University of Toronto.
Chris MeaneyBiostatistician in the Department of Family and Community Medicine at the University of Toronto.
Rahim MoineddinProfessor in the Department of Family and Community Medicine at the University of Toronto and a scientist at ICES.
Alexander SingerAssociate Professor in the Department of Family Medicine at the University of Manitoba in Winnipeg.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo assess the effectiveness of a Choosing Wisely Canada (CWC) initiative to improve thyroid-stimulating hormone (TSH) test ordering for patients with no identified indication for this test.

designRetrospective parallel cohort study using routinely collected electronic medical record (EMR) data. The CWC initiative included supporting primary care leads in each participating family health team, providing education on better test ordering, and allowing adaptation appropriate to each local context.

settingToronto, Ont, and surrounding areas.

participantsFamily physicians contributing EMR data to the University of Toronto Practice-Based Research Network and their patients aged 18 or older.

main outcome measuresProportion of adult patients with a TSH test done in a 2-year period (2016 to 2017) in the absence of EMR data with an indication for TSH testing; proportion of TSH test results in the normal range for those patients; and change in the rate of TSH screening in sites participating in the CWC initiative compared with sites not participating.

resultsA total of 150 944 patients (51.7% of studied adults) had no identified indication for TSH testing; 33.4% of those patients were seen by physicians in the family health teams participating in the CWC initiative. Overall, 35.1% of all patients with no identified indication had at least 1 TSH test between January 1, 2016, and December 31, 2017. The 119 physicians participating in the CWC initiative decreased their monthly rate of testing by 0.23% from 2016 to 2017, a relative reduction of 13.2%. The 233 physicians not participating decreased testing by 0.04%, a relative reduction of 1.8%. The monthly difference between the 2 groups was 0.19% (95% CI -0.02 to -0.35

conclusionThis study found high rates of TSH testing without identified indications in the practices studied. A CWC initiative implemented in primary care was effective in reducing TSH testing.

Indexed as

Health PromotionAdultCanadaElectronic Health RecordsFamily PracticeFemaleHumansMaleMedical OveruseMiddle AgedPractice Patterns, Physicians'Primary Health CareProgram EvaluationRetrospective StudiesThyroid Function TestsYoung Adult

Identifiers

PMID31722930
PMCPMC6853352

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.