“Send &amp; hold” clinical decision support rules improvement to reduce unnecessary testing of vitamins A, E, K, B1, B2, B3, B6 and C

Rodríguez-Borja, Enrique; Corchon-Peyrallo, Africa; Barba-Serrano, Esther; Martínez, Celia Villalba; Calvo, Arturo Carratala

doi:10.1515/cclm-2017-1031

Cited by 8 publications

(3 citation statements)

References 13 publications

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“…So far, there is little evidence of effective strategies to reduce this overtesting in general practice, although clinical decision support rules seem promising 11. Understanding barriers to, and facilitators for, reducing overtesting is essential to develop a long-term strategy to tackle this problem 10.…”

Section: Introductionmentioning

confidence: 99%

Reducing unnecessary vitamin testing in general practice: barriers and facilitators according to general practitioners and patients

et al. 2019

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ObjectiveThere has been an increase in testing of vitamins in patients in general practice, often based on irrational indications or for non-specific symptoms, causing increasing healthcare expenditures and medicalisation of patients. So far, there is little evidence of effective strategies to reduce this overtesting in general practice. Therefore, the aim of this qualitative study was to explore the barriers and facilitators for reducing the number of (unnecessary) vitamin D and B12 laboratory tests ordered.Design and settingThis qualitative study, based on a grounded theory design, used semistructured interviews among general practitioners (GPs) and patients from two primary care networks (147 GPs, 195 000 patients). These networks participated in the Reducing Vitamin Testing in Primary Care Practice (REVERT) study, a clustered randomized trial comparing two de-implementation strategies to reduce test ordering in primary care in the Netherlands.ParticipantsTwenty-one GPs, with a maximum of 1 GP per practice who took part in the REVERT study, and 22 patients (who were invited by their GP during vitamin-related consultations) were recruited, from which 20 GPs and 19 patients agreed to participate in this study.ResultsThe most important factor hampering vitamin-test reduction programmes is the mismatch between patients and medical professionals regarding the presumed appropriate indications for testing for vitamin D and B12. In contrast, the most important facilitator for vitamin-test reduction may be updating GPs’ knowledge about test indications and their awareness of their own testing behaviour.ConclusionTo achieve a sustainable reduction in vitamin testing, guidelines with clear and uniform recommendations on evidence-based indications for vitamin testing, combined with regular (individual) feedback on test-ordering behaviour, are needed. Moreover, the general public needs access to clear and reliable information on vitamin testing. Further research is required to measure the effect of these strategies on the number of vitamin test requests.Trial registration numberWAG/mb/16/039555.

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Section: Introductionmentioning

confidence: 99%

Reducing unnecessary vitamin testing in general practice: barriers and facilitators according to general practitioners and patients

et al. 2019

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“…Laleci et al [28] utilized a guideline-based CDSS to help manage the personal care plans of elders. Rodriguez et al [42] introduced a "send & hold" system, utilizing clinical decision support rules to reduce the avoidable vitamin testing.…”

Section: A Clinical Decision Support Systemsmentioning

confidence: 99%

CarePre: An Intelligent Clinical Decision Assistance System

Jin,

Yang,

Cui

et al. 2018

Preprint

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Clinical decision support systems (CDSS) are widely used to assist with medical decision making. However, CDSS typically require manually curated rules and other data which are difficult to maintain and keep up-to-date. Recent systems leverage advanced deep learning techniques and electronic health records (EHR) to provide a more timely and precise results. Many of these techniques have been developed with a common focus on predicting upcoming medical events. However, while the prediction results from these approaches are promising, their value is limited by their lack of interpretability. To address this challenge, we introduce CarePre , an intelligent clinical decision assistance system. The system extends a state-of-the-art deep learning model to predict upcoming diagnosis events for a focal patient based on his/her historical medical records. The system includes an interactive framework together with intuitive visualizations designed to support diagnosis, treatment outcome analysis, and the interpretation of the analysis results. We demonstrate the effectiveness and usefulness of CarePre system by reporting results from a quantities evaluation of the prediction algorithm and a case study and three interviews with senior physicians.

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“…Over the last decades, several studies have described efforts to improve appropriate use of laboratory tests [2,3] in hospital settings [4][5][6][7][8] as well as in primary healthcare [9,10]. Most studies describe the effects of different interventions at the laboratory level to reduce laboratory test requesting.…”

Section: Introductionmentioning

confidence: 99%

A compulsory pop-up form reduces the number of vitamin D requests from general practitioners by 25 percent

Munk

Bathum

Jørgensen

et al. 2020

Scandinavian Journal of Primary Health Care

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Objective: Healthcare costs, including costs for laboratory tests, are increasing worldwide. One example is the measurement of vitamin D. General practitioners in the Capital Region of Denmark include a vitamin D status in approximately 20% of all laboratory requisitions. This study intended to examine the effect of a compulsory pop-up form in the electronic request system on the number of vitamin D tests and to monitor the indications. Design: From 1 January 2017, we introduced a compulsory pop-up form in which the general practitioners had to state the indication for measuring vitamin D, choosing from a predefined set of indications. Intervention practitioners were compared with control practitioners before and after the intervention. Setting: General practices in the Capital Region of Denmark. Subjects: In total, 572 general practitioners and 383,964 patients were included in the period from 1 January 2016 to 31 December 2018. Main outcome measures: Number of vitamin D tests and distribution of indications. Results: We observed a drop in number of vitamin D requisitions to 70% (in 2017) and 75% (in 2018) relative to 2016. During the same period, the number of requisitions increased by 33% in a non-intervention group of practitioners. The indication 'Monitoring of treatment with vitamin D' was the most frequently used indication, recorded in 121,475 patients. Conclusion: A compulsory pop-up form reduces the number of vitamin D requests from general practitioners by 25%. The implication is that pop-up forms can be used to decrease healthcare costs.

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“Send & hold” clinical decision support rules improvement to reduce unnecessary testing of vitamins A, E, K, B1, B2, B3, B6 and C

Abstract: "Send & hold" CDSRs are a promising informatics tool that can support in utilization management and enhance the pathologist's leadership role as tests specialist.

Cited by 8 publications

References 13 publications

Reducing unnecessary vitamin testing in general practice: barriers and facilitators according to general practitioners and patients

Reducing unnecessary vitamin testing in general practice: barriers and facilitators according to general practitioners and patients

CarePre: An Intelligent Clinical Decision Assistance System

A compulsory pop-up form reduces the number of vitamin D requests from general practitioners by 25 percent

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