Abstract
BackgroundSince 2000, vitamin D requests have increased 2–6 fold with no evidence of a corresponding improvement in the health of the population. The ease of vitamin D requesting may contribue to the rapid rise in its demand and, hence, pragmatic interventions to reduce vitamin D test ordering are warranted.AimTo study the effect on vitamin D requests following a redesign of the electronic forms used in primary care. In addition, any potential harms were studied and the potential cost-savings associated with the intervention were evaluated.Design & settingAn interventional study took place within primary care across Leicestershire, England.MethodThe intervention was a redesign of the electronic laboratory request form for primary care practitioners across the county. Data were collected on vitamin D requests for a 6-month period prior to the change (October 2016 to March 2017) and the corresponding 6-month period post-intervention (October 2017 to March 2018), data were also collected on vitamin D, calcium, and phosphate levels.ResultsThe number of requests for vitamin D decreased by 14 918 (36.2%) following the intervention. Changes in the median calcium and phosphate were not clinically significant. Cost-modelling suggested that if such an intervention was implemented across primary care in the UK, there would be a potential annual saving to the NHS of £38 712 606.ConclusionA simple pragmatic redesign of the electronic request form for vitamin D test led to a significant reduction in vitamin D requests without any adverse effect on the quality of care.
Highlights
A simple pragmatic redesign of the electronic request form for vitamin D test led to a significant reduction in vitamin D requests without any adverse effect on the quality of care
Author Keywords: vitamin D, general practice, cost savings, primary healthcare, general practitioners. How this fits in Vitamin D requests have increased 2–6 fold, which has led to a 3-fold increase in medical expenditure in the UK since 2000 onwards
It is possible that the ease of vitamin D test ordering may contribute to the rapid rise in its requesting
Summary
Across varied healthcare systems, use of diagnostic tests is increasing steadily with the workload rising by 10% every year in the UK in the last two decades.[1,2,3] there has been a substantial increase in vitamin D testing and prescriptions for low vitamin D across multiple countries, including Australia, Canada, France, Saudi Arabia, US, and the UK between 2006 and 2015.4 In the UK, during the last 15–18 years, there has been a 2–6 fold increase in vitamin D requests.[4,5,6] The corresponding costs of analysis of vitamin D in primary care across the UK have increased 3-fold, with an estimated increase in annual spending of £28 million in 2004 to £76 million in 2011.4 This increase is without any clear gain in health benefits.[5] Similar to the UK-wide trend of increase in vitamin D requests, Leicestershire with a population of 1.1 million people had 63 940 vitamin D requests in 2013, which rose by around two-thirds to 102 970 in 2017. Since 2000, vitamin D requests have increased 2–6 fold with no evidence of a corresponding improvement in the health of the population. The ease of vitamin D requesting may contribue to the rapid rise in its demand and, pragmatic interventions to reduce vitamin D test ordering are warranted
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