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Implementation of an intervention to reduce population-based screening for vitamin D deficiency: a cross-sectional
Christopher Naugler1, Brenda Hemmelgarn1, Hude Quan1
1Departments of Pathology and Laboratory Medicine (Naugler, Chin), Family Medicine (Naugler, Thomas, Turin), Community Health Sciences (Hemmelgarn, Quan, Clement, Sajobi), Cumming School of Medicine, University of Calgary, Calgary, Alta; Alberta Medical Association (Hnydyk), Edmonton, Alta; Red Deer Regional Hospital Centre (Wesenberg), Clinical Laboratory, Red Deer, Alta.
Background:
We describe the implementation of an intervention in Alberta in support of the Choosing Wisely Canada recommendation against population screening for vitamin D deficiency (as determined by serum total 25-hydroxyvitamin D testing). We hypothesized that the introduction of a specialized requisition for vitamin D testing would reduce the annual number of vitamin D tests performed.
Methods:
We performed a cross-sectional observational study that included all vitamin D tests ordered in Alberta between Apr. 1, 2015, and Mar. 31, 2016. There were no exclusion criteria. A special requisition for ordering vitamin D tests in Alberta was introduced on Apr. 1, 2015. Using an interrupted time series model, we compared predicted versus observed vitamin D test volumes for the 12-month period following the introduction of the new requisition. The sole outcome measure was the monthly change in volume of vitamin D testing. In addition, we calculated any cost savings as a result of reduced testing.
Results:
Over the first 12 months of the intervention, there was a reduction in the number of tests ordered from a predicted 342 477 tests to 29 525 tests (91.4% reduction). This decrease represented a direct spending decrease of Can$938 856-$1 564 760 per year in Alberta.
Interpretation:
A provincially led implementation of a Choosing Wisely Canada recommendation resulted in a large and sustained reduction in serum total 25-hydroxyvitamin D testing in Alberta. This study shows that provincially led interventions based on Choosing Wisely Canada recommendations can result in substantial reductions in laboratory tests.