An educational intervention to increase awareness reduces unnecessary laboratory testing in an internal medicine resident-run clinic

Leung, Erika; Song, Shunfeng; Al-Abboud, Omar; Shams, Shahed; English, John; Naji, Wisam; Huang, Yafei; Robison, Leon R.; Balis, Fred; Kawsar, Hameem I.

doi:10.1080/20009666.2017.1335154

Cited by 8 publications

(7 citation statements)

References 15 publications

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“…For example, physicians received a phone call and computer message when ordering a repeat 25-OH-D test less than 90 days after the previous 25-OH-D test [ 69 ]. Finally, patient and clinician education were shown to be effective in reducing the ordering of 25-OH-D tests [ 65 , 70 ].…”

Section: Resultsmentioning

confidence: 99%

Clinical Management of Low Vitamin D: A Scoping Review of Physicians’ Practices

et al. 2018

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The role of vitamin D in the prevention and treatment of non-skeletal health issues has received significant media and research attention in recent years. Costs associated with clinical management of low vitamin D (LVD) have increased exponentially. However, no clear evidence supports vitamin D screening to improve health outcomes. Authoritative bodies and professional societies do not recommend population-wide vitamin D screening in community-dwelling adults who are asymptomatic or at low risk of LVD. To assess patterns of physicians’ management of LVD in this conflicting environment, we conducted a scoping review of three electronic databases and the gray literature. Thirty-eight records met inclusion criteria and were summarized in an evidence table. Thirteen studies published between 2006 and 2015 across seven countries showed a consistent increase in vitamin D lab tests and related costs. Many vitamin D testing patterns reflected screening rather than targeted testing for individuals at high risk of vitamin D deficiency or insufficiency. Interventions aimed at managing inappropriate clinical practices related to LVD were effective in the short term. Variability and controversy were pervasive in many aspects of vitamin D management, shining a light on physicians’ practices in the face of uncertainty. Future research is needed to inform better clinical guidelines and to assess implementation practices that encourage evidence-based management of LVD in adult populations.

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Section: Resultsmentioning

confidence: 99%

Clinical Management of Low Vitamin D: A Scoping Review of Physicians’ Practices

et al. 2018

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“…Such computerised clinical decision support systems have been found to modify clinicians test-ordering behaviour, optimise clinical time and improve the adequacy of testing 36 37. Additionally, direct physician feedback (ie, a phone call and computer message when a new vitamin D test was ordered less than 90 days after a similar previous test) and patient and clinician education have been found to be effective in improving the appropriateness of vitamin D testing 3 30 38…”

Section: Discussionmentioning

confidence: 99%

Changes to the frequency and appropriateness of vitamin D testing after the introduction of new Medicare criteria for rebates in Australian general practice: evidence from 1.5 million patients in the NPS MedicineInsight database

Gonzalez-Chica

Stocks

2019

BMJ Open

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ObjectivesTo assess changes in the frequency of vitamin D testing and detection of moderate/severe vitamin D deficiency (<30 nmol/L) among adults after the introduction of new Medicare Benefits Schedule (MBS) rebate criteria (November 2014), and their relationship to sociodemographic and clinical characteristics.DesignDynamic (open) cohort studySettingPrimary careParticipantsAbout 1.5 million ‘active’ patients aged 18+ years visiting a general practitioner and included in the National Prescribing Service MedicineInsight database.Outcome measuresThe frequency of vitamin D testing (per 1000 consultations) and moderate/severe vitamin D deficiency (%) recorded between October 2013 and March 2016, stratified by the release of the new MBS criteria for rebate.ResultsMore patients were female (57.7%) and 30.2% were aged 60+ years. Vitamin D testing decreased 47% (from 40.3 to 21.4 tests per 1000 consultations) after the new MBS criteria, while the proportion of tests with no indication for being performed increased from 71.3% to 76.5%. The proportion of patients identified as moderate/severe vitamin D deficient among those tested increased from 5.4% to 6.5%. Practices located in high socioeconomic areas continued to have the highest rates of testing, but moderate/severe vitamin D deficiency detection remained 90% more frequent in practices from low socioeconomic areas after the rebate change. Furthermore, the frequency of individuals being tested was reduced independent of the patients’ sociodemographic or clinical condition, and the gap in the prevalence of vitamin D deficiency detection between those meeting or not meeting the criteria for being tested remained the same. Moderate/severe vitamin D deficiency detection decreased slightly among patients with hyperparathyroidism or chronic renal failure.ConclusionsAlthough the new criteria for rebate almost halved the frequency of vitamin D testing, it also lessened the frequency of testing among those at higher risk of deficiency, with only a small improvement in vitamin D deficiency detection.

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“…2019;143:1531-1538; doi: 10.5858/arpa.2018-0625-CP) V itamin D measurement techniques and proper utilization have been a source of interesting debate in the laboratory medicine community for quite some time. [1][2][3][4][5][6][7][8][9][10] Vitamin D is made up of several fat-soluble secosteroids. 11,12 The 2 major forms of vitamin D are vitamin D 2 or ergocalciferol, which is derived from plants, and vitamin D 3 or cholecalciferol, which is derived from animal sources.…”

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confidence: 99%

Accuracy-Based Vitamin D Survey: Six Years of Quality Improvement Guided by Proficiency Testing

Erdman

Palmer-Toy

Horowitz

et al. 2019

Archives of Pathology &Amp; Laboratory Medicine

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Context.— The goal of the College of American Pathologists Accuracy-Based Proficiency Testing Program is to promote the quality, standardization, and harmonization of clinical laboratory results through proficiency testing specimens that are free from matrix effects, have target values that are traceable to reference methods, and that probe the limitations of current methods. Objective.— To summarize the first 6 years of the Accuracy-Based Vitamin D Survey and highlight key insights from the data generated as it relates to assay performance. Design.— Accuracy-based challenges were created by using pooled human serum samples. Certain samples were derived from participants in an institutional review board–approved protocol in which vitamin D–deficient participants were treated with ergocalciferol (vitamin D2). Reference targets for the survey were set by the Centers for Disease Control and Prevention using isotope-dilution liquid chromatography–tandem mass spectrometry. Each method was compared with the reference method procedure over the course of the program (n = 43 proficiency testing samples). Results.— Linear regression versus the reference method procedure revealed proportional biases across the methods, ranging from 0.0% to 16.7%. Pearson correlation coefficients ( r2) ranged from 0.902 to 0.996. Results were influenced by the concentration of 25-hydroxyvitamin D2 as well as the C-3 epimer of 25-hydroxyvitamin D3. During the 6 years, 2 manufacturers altered their assays to match the reference method procedure more closely. Conclusions.— There is considerable bias, both proportional bias and sample-specific matrix effects, affecting many assays. This ongoing accuracy-based proficiency testing program for vitamin D will provide the data needed for laboratories and manufacturers to improve their assays and thereby patient care.

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An educational intervention to increase awareness reduces unnecessary laboratory testing in an internal medicine resident-run clinic

Cited by 8 publications

References 15 publications

Clinical Management of Low Vitamin D: A Scoping Review of Physicians’ Practices

Clinical Management of Low Vitamin D: A Scoping Review of Physicians’ Practices

Changes to the frequency and appropriateness of vitamin D testing after the introduction of new Medicare criteria for rebates in Australian general practice: evidence from 1.5 million patients in the NPS MedicineInsight database

Accuracy-Based Vitamin D Survey: Six Years of Quality Improvement Guided by Proficiency Testing

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