Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.
Adelaide Rural Clinical School, University of Adelaide, Adelaide, South Australia, Australia.
BMJ Open. 2019 Mar 8;9(3):e024797. doi: 10.1136/bmjopen-2018-024797.
To assess changes in the frequency of vitamin D testing and detection of moderate/severe vitamin D deficiency (<30 nmol/L) among adults after the introduction of new Medicare Benefits Schedule (MBS) rebate criteria (November 2014), and their relationship to sociodemographic and clinical characteristics.
Dynamic (open) cohort study SETTING: Primary care PARTICIPANTS: About 1.5 million 'active' patients aged 18+ years visiting a general practitioner and included in the National Prescribing Service MedicineInsight database.
The frequency of vitamin D testing (per 1000 consultations) and moderate/severe vitamin D deficiency (%) recorded between October 2013 and March 2016, stratified by the release of the new MBS criteria for rebate.
More patients were female (57.7%) and 30.2% were aged 60+ years. Vitamin D testing decreased 47% (from 40.3 to 21.4 tests per 1000 consultations) after the new MBS criteria, while the proportion of tests with no indication for being performed increased from 71.3% to 76.5%. The proportion of patients identified as moderate/severe vitamin D deficient among those tested increased from 5.4% to 6.5%. Practices located in high socioeconomic areas continued to have the highest rates of testing, but moderate/severe vitamin D deficiency detection remained 90% more frequent in practices from low socioeconomic areas after the rebate change. Furthermore, the frequency of individuals being tested was reduced independent of the patients' sociodemographic or clinical condition, and the gap in the prevalence of vitamin D deficiency detection between those meeting or not meeting the criteria for being tested remained the same. Moderate/severe vitamin D deficiency detection decreased slightly among patients with hyperparathyroidism or chronic renal failure.
Although the new criteria for rebate almost halved the frequency of vitamin D testing, it also lessened the frequency of testing among those at higher risk of deficiency, with only a small improvement in vitamin D deficiency detection.
评估在新的医疗保险福利计划（MBS）回扣标准（2014 年 11 月）出台后，成年人维生素 D 检测频率和中度/重度维生素 D 缺乏症（<30nmol/L）的检出率的变化，并分析其与社会人口学和临床特征的关系。
动态（开放）队列研究
初级保健
大约 150 万 18 岁以上“活跃”患者，他们在国家处方服务药物洞察数据库中接受全科医生的治疗。
在 2013 年 10 月至 2016 年 3 月期间，根据新的 MBS 回扣标准的发布，记录了维生素 D 检测（每 1000 次就诊的次数）和中度/重度维生素 D 缺乏症（%）的频率，按新 MBS 标准进行分层。
患者中女性（57.7%）居多，30.2%的患者年龄在 60 岁以上。新 MBS 标准出台后，维生素 D 检测量下降了 47%（从每 1000 次就诊的 40.3 次降至 21.4 次），而无指征检测的比例从 71.3%上升至 76.5%。在接受检测的患者中，被诊断为中度/重度维生素 D 缺乏症的患者比例从 5.4%上升至 6.5%。位于高社会经济地区的诊所继续保持最高的检测率，但在回扣政策改变后，来自低社会经济地区的诊所检测到中度/重度维生素 D 缺乏症的比例仍高出 90%。此外，个体检测的频率降低与患者的社会人口学或临床状况无关，且符合或不符合检测标准的患者中维生素 D 缺乏症检出率的差距保持不变。在甲状旁腺功能亢进或慢性肾功能衰竭患者中，中度/重度维生素 D 缺乏症的检出率略有下降。
尽管新的回扣标准将维生素 D 检测的频率降低了近一半，但也减少了缺乏症高危人群的检测频率，而维生素 D 缺乏症的检出率仅略有改善。
