Celia Rodd1, AbdulRazaq Sokoro2, Lisa M Lix3, Laurel Thorlacius4, Michael Moffatt5, Jim Slater6, Eric Bohm7. 1. Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada. Electronic address: crodd@hsc.mb.ca. 2. Clinical Biochemistry, Shared Health*, and Departments of Internal Medicine and Pathology, University of Manitoba, Canada. 3. Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Canada. 4. Clinical Biochemistry, Shared Health*, Department of Pathology, Department of Biochemistry and Medical Genetics, University of Manitoba, Canada. 5. Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada. 6. Shared Health*, Department of Pathology, University of Manitoba, Canada. 7. George and Fay Yee Centre for Health Care Innovation and Department of Surgery, University of Manitoba, Winnipeg. Manitoba, Canada.
Abstract
INTRODUCTION: Laboratories have noted marked increases in the analysis of 25-hydroxy vitamin D (25(OH)D) in recent decades. Our objectives were to describe the annual number of 25(OH)D tests, examine the characteristics of those tested and those ordering them, and determine the proportion of potentially unnecessary tests in Manitoba. METHODS: Manitoba residents who were tested between 2006/7 and 2012/13 had their data anonymously linked to Manitoba Centre for Health Policy comprehensive administrative datasets. Patient and physician characteristics, location of residence, and 25(OH)D concentrations were determined. Descriptive statistics and multivariable regression models were utilized. RESULTS: There was a quadrupling in testing from 2006 to 2013, with >20,000 tests performed in 2012/13. The median annual number of tests was one per patient; the maximum was >10 tests per year. Adult females had twice the number of tests compared to males (p < 0.001). There was a rise in 25(OH)D concentrations over time with hypervitaminosis D increasing disproportionately (2006/7 to 212/13 (0% vs. 0.15%, p < 0.001)). Apparently unnecessary testing rose by 1/3 over time, frequently ordered by Family Medicine practitioners. A revised 25(OH)D requisition resulted in striking reduction of 25(OH)D requests (~80%). DISCUSSION: Manitoba noted a rapid increase in testing, and rise in 25(OH)D concentrations with levels that may be associated with toxicities; both have been reported in other jurisdictions. There appeared to a striking rise in 'unnecessary' tests. We similarly report the benefit of the implementation of a mandatory requisition specifying eligibility criteria for 25(OH)D and education about appropriate testing.
INTRODUCTION: Laboratories have noted marked increases in the analysis of 25-hydroxy vitamin D (25(OH)D) in recent decades. Our objectives were to describe the annual number of 25(OH)D tests, examine the characteristics of those tested and those ordering them, and determine the proportion of potentially unnecessary tests in Manitoba. METHODS: Manitoba residents who were tested between 2006/7 and 2012/13 had their data anonymously linked to Manitoba Centre for Health Policy comprehensive administrative datasets. Patient and physician characteristics, location of residence, and 25(OH)D concentrations were determined. Descriptive statistics and multivariable regression models were utilized. RESULTS: There was a quadrupling in testing from 2006 to 2013, with >20,000 tests performed in 2012/13. The median annual number of tests was one per patient; the maximum was >10 tests per year. Adult females had twice the number of tests compared to males (p < 0.001). There was a rise in 25(OH)D concentrations over time with hypervitaminosis D increasing disproportionately (2006/7 to 212/13 (0% vs. 0.15%, p < 0.001)). Apparently unnecessary testing rose by 1/3 over time, frequently ordered by Family Medicine practitioners. A revised 25(OH)D requisition resulted in striking reduction of 25(OH)D requests (~80%). DISCUSSION: Manitoba noted a rapid increase in testing, and rise in 25(OH)D concentrations with levels that may be associated with toxicities; both have been reported in other jurisdictions. There appeared to a striking rise in 'unnecessary' tests. We similarly report the benefit of the implementation of a mandatory requisition specifying eligibility criteria for 25(OH)D and education about appropriate testing.
Authors: Chase D Hendrickson; Michael F McLemore; Kathryn M Dahir; Shari Just; Zahra Shajani-Yi; Joseph LeGrand; Christoph U Lehmann; Asli Weitkamp Journal: Appl Clin Inform Date: 2020-02-26 Impact factor: 2.342
Authors: Alyssa A Kerber; Mitchell M Pitlick; Anna E Kellund; Amy L Weaver; Seema Kumar; Avni Y Joshi Journal: J Pediatr Date: 2021-07-20 Impact factor: 6.314