Salinas Maria, López-Garrigós Maite, Pomares Francisco J, Flores Emilio, Uris Joaquín, Leiva-Salinas Carlos
Servicio de Análisis Clínicos, Hospital Universitario de San Juan, San Juan de Alicante, España; Departamento de Bioquímica y Biología Molecular, Universidad Miguel Hernández, Elche, España.
Servicio de Análisis Clínicos, Hospital Universitario de San Juan, San Juan de Alicante, España; Departamento de Bioquímica y Biología Molecular, Universidad Miguel Hernández, Elche, España.
Endocrinol Nutr. 2016 Jan;63(1):19-26. doi: 10.1016/j.endonu.2015.06.011. Epub 2015 Nov 6.
Laboratory tests are crucial for diagnosis and monitoring of thyroid disorders. It is therefore necessary to study the pattern and variability in requests of thyroid function tests. The study objectives were to compare the inter-regional variability in the request of laboratory thyroid tests by general practitioners (GPs) in Spain, and to investigate the potential economic savings if the goals set for some suitability indicators were reached.
Test requests per 1,000 inhabitants and test ratios (free thyroxine (FT4)/thyrotropin (TSH), free triiodothyronine (FT3)/TSH, thyroglobulin antibody (TgAb)/peroxidase antibody (TPOAb)) were compared between the different areas, according to their setting, location, and management. The resulting savings if each department achieved the goals for indicator (0.25 for FT4/TSH, 0.1 for FT3/TSH) were estimated.
Seventy-six laboratories covering a population of 17,679,195 inhabitants participated in the study. TSH was requested significantly less in urban-rural areas, and the requests for FT3/1,000 inhabitants, FT3/TSH, and TgAb/TPOAb were higher in departments with private management. The savings generated if specifications for the ratios of related tests were met would be 937,260.5 €.
The high variability reported in requests for thyroid function and autoimmunity tests in Spain suggests the need for implementing strategies to improve use of such tests.
实验室检查对于甲状腺疾病的诊断和监测至关重要。因此，研究甲状腺功能检查申请的模式和变异性很有必要。本研究的目的是比较西班牙全科医生（GP）对实验室甲状腺检查申请的地区间变异性，并调查如果达到某些适宜性指标所设定的目标可能节省的经济成本。
根据不同地区的设置、位置和管理情况，比较每1000名居民的检查申请数量以及检查比率（游离甲状腺素（FT4）/促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（FT3）/TSH、甲状腺球蛋白抗体（TgAb）/过氧化物酶抗体（TPOAb））。估算了如果每个部门达到指标目标（FT4/TSH为0.25，FT3/TSH为0.1）所产生的节省成本。
76个实验室参与了该研究，覆盖人口达17,679,195名居民。城乡地区促甲状腺激素的申请量显著较少，在实行私营管理的部门中，每1000名居民的FT3申请量、FT3/TSH以及TgAb/TPOAb的申请量更高。如果相关检查比率符合规范，所产生的节省成本将为937,260.5欧元。
西班牙甲状腺功能和自身免疫检查申请中报告的高度变异性表明需要实施策略来改善此类检查的使用情况。
