Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
BMJ Open. 2019 Oct 7;9(10):e029760. doi: 10.1136/bmjopen-2019-029760.
There has been an increase in testing of vitamins in patients in general practice, often based on irrational indications or for non-specific symptoms, causing increasing healthcare expenditures and medicalisation of patients. So far, there is little evidence of effective strategies to reduce this overtesting in general practice. Therefore, the aim of this qualitative study was to explore the barriers and facilitators for reducing the number of (unnecessary) vitamin D and B laboratory tests ordered.
This qualitative study, based on a grounded theory design, used semistructured interviews among general practitioners (GPs) and patients from two primary care networks (147 GPs, 195 000 patients). These networks participated in the Reducing Vitamin Testing in Primary Care Practice (REVERT) study, a clustered randomized trial comparing two de-implementation strategies to reduce test ordering in primary care in the Netherlands.
Twenty-one GPs, with a maximum of 1 GP per practice who took part in the REVERT study, and 22 patients (who were invited by their GP during vitamin-related consultations) were recruited, from which 20 GPs and 19 patients agreed to participate in this study.
The most important factor hampering vitamin-test reduction programmes is the mismatch between patients and medical professionals regarding the presumed appropriate indications for testing for vitamin D and B. In contrast, the most important facilitator for vitamin-test reduction may be updating GPs' knowledge about test indications and their awareness of their own testing behaviour.
To achieve a sustainable reduction in vitamin testing, guidelines with clear and uniform recommendations on evidence-based indications for vitamin testing, combined with regular (individual) feedback on test-ordering behaviour, are needed. Moreover, the general public needs access to clear and reliable information on vitamin testing. Further research is required to measure the effect of these strategies on the number of vitamin test requests.
WAG/mb/16/039555.
在全科医疗中，对维生素的检测有所增加，通常基于不合理的指征或非特异性症状，导致医疗保健支出增加和患者的医学化。到目前为止，几乎没有证据表明有有效的策略可以减少全科医疗中的这种过度检测。因此，本定性研究的目的是探讨减少（不必要的）维生素 D 和 B 实验室检测数量的障碍和促进因素。
这项定性研究基于扎根理论设计，在两个初级保健网络（147 名全科医生和 195000 名患者）中对全科医生和患者进行了半结构化访谈。这些网络参加了“减少初级保健实践中的维生素检测”（REVERT）研究，这是一项在荷兰比较两种实施策略以减少初级保健中检测订单的集群随机试验。
从参加 REVERT 研究的最多每家诊所 1 名全科医生中选择了 21 名全科医生，以及 22 名患者（由他们的全科医生在与维生素相关的咨询中邀请），其中 20 名全科医生和 19 名患者同意参加本研究。
阻碍维生素检测减少计划的最重要因素是患者和医疗专业人员对维生素 D 和 B 检测的预期适当指征之间的不匹配。相比之下，维生素检测减少的最重要促进因素可能是更新全科医生关于检测指征的知识，以及他们对自己检测行为的认识。
为了实现维生素检测的可持续减少，需要有明确和统一的基于证据的维生素检测指征指南，并结合对检测订单行为的定期（个体）反馈。此外，公众需要获得关于维生素检测的清晰可靠的信息。需要进一步研究这些策略对维生素检测请求数量的影响。
WAG/mb/16/039555。
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