Changes/updates to thyroid testing policy

Belinda Hodson made this Official Information request to Waikato District Health Board

Response to this request is delayed. By law, Waikato District Health Board should normally have responded promptly and by (details and exceptions)

From: Belinda Hodson

Dear Waikato District Health Board,

Please provide all policy updates/changes to all thyroid tests (TSH, Free T3, RT3, thyroid anti-body etc.) recommended by Pathlab and approved by the Waikato DHB for implementation by Pathlab; and implemented by Pathlab, during the period 1st January 2010 to 20 July 2018; along with:
a) the rationale for these updates/changes and the citation list of the clinical publications supporting these changes/updates (clinical research studies and other clinical papers including guidelines referenced); plus
b) the associated ‘clinical updates’ for these changes/updates that have been posted in the clinicians information area of Pathlab's website.

2. Copies of reports of these updates/changes provided to the Waikato District Health Board by Pathlab or produced by the Waikato District Health Board which monitor the impact of these updates/changes on patient's health and well-being.

Yours faithfully,

Belinda Hodson

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From: Rebecca Walker
Waikato District Health Board

Good Morning

This is to acknowledge receipt of your request for information. I have passed through to the appropriate service and will provide a response as soon as the information is available, noting the requirement to provide reply by 24 August.

Kind regards
Rebecca

Rebecca Walker | PA to Tanya Maloney, Executive Director Strategy, Funding and Public Health | Waikato DHB

Level 9, KPMG building, 85 Alexandra Street, Hamilton
p 027 208 0968 | e [email address]

Give and Earn Respect – Whakamana Stronger Together – Kotahitanga Fair Play – Mauri Pai
Listen to me, talk to me – Whakarongo Growing the good – Whakapakari

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From: Carole Muriwai
Waikato District Health Board


Attachment image001.png
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Attachment Response to B Hodson final.pdf
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Attachment Attachments for Pathlab OIA B Hodson.pdf
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Carole Muriwai

 

PA to Phil Grady – Interim Executive Director of Strategy,  Funding and
Public Health

 

L9 KPMG Building | 85 Alexandra St, Hamilton | Private Bag 3200 | Hamilton
| Tel (07) 834 3646 | email [1][email address]

 

Waikato DHB Values: “People at Heart” – Te iwi Ngakaunui
[2]cid:image004.png@01D44F56.40DA3110

[3]cid:image003.png@01D44F56.40D01EF0Give and earn respect -
Whakamana[4]cid:image003.png@01D44F56.40D01EF0Listen to me; talk to me –
Whakarongo[5]cid:image003.png@01D44F56.40D01EF0Fair play – Mauri
Pai[6]cid:image003.png@01D44F56.40D01EF0Growing the good –
Whakapakari[7]cid:image003.png@01D44F56.40D01EF0Stronger together –
Kotahitanga

 

 

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From: Belinda Hodson

Dear Carole Muriwai,

In this OIA, we asked for citation lists supporting all thyroid testing policy changes/updates. A reference to BPAC guidance has been made but not citation lists e.g. published clinical studies and other research papers supporting Waikato DHB approved /Pathlab thyroid testing policies.

Can you/Pathlab please provide these as requested.

Yours sincerely,

Belinda Hodson

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From: Belinda Hodson

Dear Carole Muriwai,

Thank you for providing this response to the OIA request. In this response it says:

“The hospital chemical pathologist advised the group that we are following BPAC Guidelines. He reviewed all evidence submitted by TANZi and remains unconvinced.

GPs used to order T3, T4, TSH – for unknown reasons, there is interference between the tests and the follow-ups are extremely expensive and convoluted with no outcome i.e. they are causing patients harm.”

Please provide copies of the clinical studies carried out by Pathlab or the Waikato DHB, citation lists and other NZ or international clinical data that supports this last sentence about patients being harmed by GPs ordering the T3, T4 and TSH test. If you wish to classify this as another OIA Request because it is a question arising from the response to this OIA, waiting for 20 working days for a response from today is fine.

Yours sincerely,

Belinda Hodson

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From: Carole Muriwai
Waikato District Health Board

Good morning Belinda

Just acknowledging your 2 emails I received yesterday afternoon relating to your OIA request.

Regards

Carole Muriwai

PA to Phil Grady – Interim Executive Director of Strategy, Funding and Public Health

L9 KPMG Building | 85 Alexandra St, Hamilton | Private Bag 3200 | Hamilton | Tel (07) 834 3646 | email [email address]

Waikato DHB Values: “People at Heart” – Te iwi Ngakaunui
Give and earn respect - WhakamanaListen to me; talk to me – WhakarongoFair play – Mauri PaiGrowing the good – WhakapakariStronger together – Kotahitanga

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From: Carole Muriwai
Waikato District Health Board


Attachment Response to B Hodson 2nd request.pdf
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Good morning Ms Hodson

Please see attached reply to your email you sent.

Regards

Carole Muriwai

PA to Phil Grady – Interim Executive Director of Strategy, Funding and Public Health

L9 KPMG Building | 85 Alexandra St, Hamilton | Private Bag 3200 | Hamilton | Tel (07) 834 3646 | email [email address]

Waikato DHB Values: “People at Heart” – Te iwi Ngakaunui
Give and earn respect - WhakamanaListen to me; talk to me – WhakarongoFair play – Mauri PaiGrowing the good – WhakapakariStronger together – Kotahitanga

show quoted sections

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From: Belinda Hodson

Dear Carole Muriwai,

Thank you for your 16th September 2019 reply to the two emails I sent on 12 September 2019 in reply to OIA raised on 29 July 2019 “Changes/updates to thyroid testing policy”. One email on 12 September 2019 requested additional information and the other requested information that was asked for in the OIA but not provided in the response, with no reason given for not providing the information.

1. Information that was asked for in the OIA but not provided in the response with no reason given

In the 29 July 2019 OIA, I asked for citation lists supporting thyroid testing policy changes/updates. A reference to BPAC guidance was made but not citation lists e.g. published clinical studies and other research papers supporting Waikato DHB approved /Pathlab thyroid testing policies.

In the 16th September 2019 reply Phillip O'Grady states:

“As this information is publicly available through a search of the relevant reputable medical journals we will not be providing this information. As you are able to access this information yourself, we are refusing your request under section 18(d) of the OIA.”

Some of the studies will be available through a search of the relevant reputable medical journals. However, as a member of the public, I do not have access to all databases used by medical professionals and chemical lab pathologists to source clinical publications. In addition, a general search will not tell me which out of hundreds of clinical studies are the ones being used to support Pathlab and the Waikato DHB in their development of thyroid policies changes and updates. It is the specific citations used by Pathlab and the Waikato DHB that I am asking for, not a general list. It is thus not possible for me to accurately locate the specific citation lists for Pathlab and the Waikato DHB’s thyroid testing updates/changes and that is why it is reasonable for me to request this list directly from yourselves. The clinical publications included in the Thyroid Association of NZ’s letter of complaint to the Waikato DHB on Pathlab’s thyroid testing policies which was referenced in the response to this OIA, are not being used to inform changes/updates to the Waikato DHB and Pathlab’s thyroid testing policies so it is clear that the Waikato DHB and Pathlab are using evidence from some clinical publications on thyroid testing and not others. A search on my own will not identify which ones. I once again ask that these citation lists are provided.

2. Additional information to the 29 July 2019 OIA

With regards to the following statement made in the response to my 29 July 2019 OIA Request, I asked for copies of the clinical studies carried out by Pathlab or the Waikato DHB, citation lists and other NZ or international clinical data that supports this statement about patients being harmed by GPs ordering the T3, T4 and TSH test:

“The hospital chemical pathologist advised the group that we are following BPAC Guidelines. He reviewed all evidence submitted by TANZi [Thyroid Association NZ] and remains unconvinced.

GPs used to order T3, T4, TSH – for unknown reasons, there is interference between the tests and the follow-ups are extremely expensive and convoluted with no outcome i.e. they are causing patients harm.”

It is reasonable to request the specific citations used to back this claim as there is disagreement about this in the international endocrinology community and so a general search in a publicly accessible medical database of reputable journals, is not going to identify which citations the hospital chemical pathologist is referring to, in support of their statement above. Interferences extends to other illnesses present in patients that may affect thyroid test results e.g. non-thyroidal illness. My request for citations includes clinical studies/supporting data on actual patients that shows that non-thyroidal illness is present in patients in many cases at the time they are having their thyroid blood tests taken.

I once again ask for copies of the clinical studies carried out by Pathlab or the Waikato DHB, citation lists and other NZ or international clinical data that supports this last sentence about patients being harmed by GPs ordering the T3, T4 and TSH test.

Yours sincerely,

Belinda Hodson

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