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Less is more: Two automated interventions to increase vitamin B12 measurement when long-term proton pump inhibitor

Maria Salinas1, Maite López-Garrigós2, Emilio Flores3

  • 1Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain; Department of Biochemistry and Molecular Pathology, Universidad Miguel Hernandez, Elche, Spain.

Clinica Chimica Acta; International Journal of Clinical Chemistry
|April 3, 2020
PubMed
Summary
This summary is machine-generated.

Automated interventions improved vitamin B12 deficiency diagnosis in long-term proton pump inhibitor users. This strategy reduced unnecessary testing and laboratory costs, enhancing patient care.

Keywords:
AppropriatenessDemand managementOveruseUnderuseVitamin B(12)

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Area of Science:

  • Clinical Chemistry
  • Laboratory Medicine
  • Pharmacology

Background:

  • Long-term proton pump inhibitor (PPI) use is associated with vitamin B12 deficiency.
  • Inadequate monitoring of serum vitamin B12 (s-vitamin B12) levels is a clinical challenge.
  • Optimizing diagnostic testing for vitamin B12 deficiency is crucial in patients on long-term PPI therapy.

Purpose of the Study:

  • To evaluate two automated interventions aimed at improving s-vitamin B12 measurement in patients using PPIs long-term.
  • To reduce the incidence of inadequate and redundant s-vitamin B12 testing.
  • To assess the diagnostic yield and cost-effectiveness of the implemented interventions.

Main Methods:

  • Implementation of a Laboratory Information System (LIS) alert for s-vitamin B12 testing in eligible patients.
  • LIS-based reporting of previous s-vitamin B12 results to prevent repeat testing within three months.
  • Calculation of new vitamin B12 deficiency diagnoses, tests per case, and associated costs.

Main Results:

  • The interventions led to the measurement of 548 additional s-vitamin B12 tests, identifying 47 new cases of vitamin B12 deficiency.
  • An average of 12 added tests were required to detect one new case of deficiency.
  • The second intervention successfully avoided 611 unnecessary tests, resulting in savings of 1613€.

Conclusions:

  • Automated LIS interventions effectively enhance the diagnosis of vitamin B12 deficiency in patients on long-term PPIs.
  • These strategies significantly decrease redundant s-vitamin B12 testing, leading to substantial cost reductions.
  • The findings support the integration of automated alerts and retest intervals to optimize laboratory testing and patient management.