Veena Patel1, Clare Gillies2,3, Prashanth Patel2,4,5, Timothy Davies4, Sajeda Hansdot2, Virginia Lee6, Mayur Lakhani7, Kamlesh Khunti2,5, Pankaj Gupta2,4,5. 1. Department of Rheumatology, University Hospitals of Leicester NHS Trust, Leicester, UK. 2. Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK. 3. Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK. 4. Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, Leicester, UK. 5. NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital University Hospitals of Leicester NHS Trust, Leicester, UK. 6. Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, Leicester, UK Virginia.lee@uhl-tr.nhs.uk. 7. West Leicestershire Clinical Commissioning Group, Leicester, UK.
Abstract
BACKGROUND: 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, hence, pragmatic interventions to reduce vitamin D test ordering are warranted. AIM: To 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 & SETTING: An interventional study took place within primary care across Leicestershire, England. METHOD: The 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. RESULTS: The 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. CONCLUSION: 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.
BACKGROUND: 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, hence, pragmatic interventions to reduce vitamin D test ordering are warranted. AIM: To 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 & SETTING: An interventional study took place within primary care across Leicestershire, England. METHOD: The 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. RESULTS: The 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. CONCLUSION: 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.
Authors: Christopher Naugler; Brenda Hemmelgarn; Hude Quan; Fiona Clement; Tolulope Sajobi; Roger Thomas; Tanvir C Turin; William Hnydyk; Alex Chin; James Wesenberg Journal: CMAJ Open Date: 2017-01-17
Authors: Carlos Manuel Silva Martins; Andreia Sofia da Costa Teixeira; Luís Filipe Ribeiro de Azevedo; Luísa Maria Barbosa Sá; Paulo Alexandre Azevedo Pereira Santos; Maria Luciana Gomes Domingues do Couto; Altamiro Manuel Rodrigues da Costa Pereira; Alberto Augusto Oliveira Pinto Hespanhol; Cristina Maria Nogueira da Costa Santos Journal: BMC Med Inform Decis Mak Date: 2017-02-20 Impact factor: 2.796
Authors: Jack W O'Sullivan; Sarah Stevens; F D Richard Hobbs; Chris Salisbury; Paul Little; Ben Goldacre; Clare Bankhead; Jeffrey K Aronson; Rafael Perera; Carl Heneghan Journal: BMJ Date: 2018-11-28