Vugt Saskia van, de Schepper Evelien, van Delft Sanne, Zuithoff Nicolaas, de Wit Niek, Bindels Patrick
Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands.
BJGP Open. 2021 Dec 14;5(6). doi: 10.3399/BJGPO.2021.0113. Print 2021.
Vitamin tests are increasingly ordered by GPs, but a clinical and evidence-based indication is often lacking. Harnessing technology (that is, decision support tools and redesigning request forms) have been shown to reduce vitamin requests.
To investigate whether the number of vitamin tests may be reduced by providing a multi-level intervention programme based on training, monitoring, and feedback.
DESIGN & SETTING: This was a cluster randomised intervention study performed in 26 primary care health centres (>195 000 patients) in the Netherlands. The relative reduction in ordered vitamin D and B12 tests was determined after introduction of two de-implementation strategies (1 May 2017 to 30 April 2018).
Health centres randomised to de-implementation strategy 1 received education and benchmarking of their own vitamin test ordering behaviour every 3 months. Health centres in de-implementation strategy 2 received the same education and benchmarking, but supplemented with educational material for patients.
The number of vitamin D tests decreased by 23% compared to the 1-year pre-intervention period (1 May 2016 to 30 April 2017). For vitamin B12 tests an overall reduction of 20% was found. Provision of patient educational information showed additional value over training and benchmarking of GPs alone for vitamin D test ordering (10% extra reduction, odds ratio [OR] 0.88, 95% confidence interval [CI] = 0.83 to 0.92), but not for vitamin B12 ordering (4% extra reduction, OR 0.96, 95% CI = 0.91 to 1.02). Nationwide, this would result in over €3 200 000 in savings on healthcare expenditure a year.
A structured intervention programme, including training and benchmarking of GPs regarding their diagnostic test ordering, resulted in a significant reduction in ordered vitamin tests. Additional information provision to patients resulted in a small but still relevant additional reduction. If implemented on a national level, a substantial cost saving could be achieved.
全科医生越来越多地要求进行维生素检测，但往往缺乏临床和循证依据。利用技术（即决策支持工具和重新设计申请表）已被证明可减少维生素检测申请。
研究通过提供基于培训、监测和反馈的多层次干预计划，是否可以减少维生素检测的数量。
这是一项在荷兰26个初级保健健康中心（超过195000名患者）进行的整群随机干预研究。在引入两种去实施策略（2017年5月1日至2018年4月30日）后，确定了维生素D和B12检测申请的相对减少情况。
随机分配到去实施策略1的健康中心每3个月接受一次关于自身维生素检测申请行为的教育和基准评估。去实施策略2的健康中心接受相同的教育和基准评估，但补充了针对患者的教育材料。
与干预前一年（2016年5月1日至2017年4月30日）相比，维生素D检测数量减少了23%。维生素B12检测总体减少了20%。提供患者教育信息在维生素D检测申请方面显示出比仅对全科医生进行培训和基准评估更有额外价值（额外减少10%，优势比[OR]0.88，95%置信区间[CI]=0.83至0.92），但在维生素B12检测申请方面没有（额外减少4%，OR 0.96，95%CI=0.91至1.02）。在全国范围内，这将每年节省超过320万欧元的医疗保健支出。
一个结构化的干预计划，包括对全科医生进行诊断检测申请方面的培训和基准评估，导致维生素检测申请显著减少。向患者提供额外信息导致了虽小但仍相关的额外减少。如果在全国范围内实施，可以实现大量成本节约。
