Adecuación de las solicitudes analíticas de vitamina D en atención primaria

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ObjectiveEvaluate the adequacy of the vitaminD (VD) requests. To analyze the relationship of serum levels with the presence of risk factors for VD deficit. LocationPrimary Care Service that serves 441,198 people over 14. ParticipantsPersons over 14years of age with a VD determination in 2016. DesignRetrospective descriptive observational study. Main measurementsAge, gender, analytical month. Risk factors: institutionalization, patient in home care, obesity, chronic kidney disease (CKD), chronic liver disease or malabsorption (MN), treatment with antiepileptics or corticosteroids. Other variables: osteoporosis, treatment with antiosteoporotic, VD, calcium.The requests were considered adequate in patients with some risk factor. We consider deficit VD concentrations <20ng/mL and insufficiency between 20-30ng/mL. Descriptive statistical analysisThe difference in VD levels between risk groups and population without risk criteria is analyzed. A logistic regression analysis is performed. ResultsA total of 7,287 requests of VD. 83.9% women. Mean age: 64.57years (SD: 15). 2.5% admitted to residences and 5.7% patients in home care; 13.3% CKD, 23.3% obesity, 0.5% chronic liver disease, 1.4% MN, 8.3% were taking antiepileptic drugs and 1.3% corticosteroids. In 57.5% the requests was considered adequate. They presented a deficit of 45.75%. The deficit was significantly more frequent in the institutionalized, obese and with CKD. 60% of the subjects with deficit did not receive VD. Conclusions57.5% of the requests were adequate. The deficit was associated with institutionalization, patient in home care, obesity and CKD. The majority of patients with deficit did not receive VD. The increase in requests is not supported by the available evidence confirming the existence of a true “fashion” of the VD. For this reason it is necessary to develop protocols that help decision-making, to avoid the high health costs that may be generated by unjustified requests and treatments without benefit for the patient.