Reducing vitamin D requests in a primary care cohort: a quality improvement study

Area of Science:

• Clinical Chemistry
• Health Services Research
• Primary Care Medicine

Background:

• Vitamin D test requests have surged significantly since 2000 without clear population health benefits.
• The ease of ordering vitamin D tests likely contributes to increased demand, necessitating interventions to optimize test ordering.

Purpose of the Study:

• To assess the impact of redesigned electronic laboratory request forms on vitamin D test ordering in primary care.
• To evaluate any potential adverse effects and cost savings associated with this intervention.

Main Methods:

• An interventional study was conducted in primary care settings in Leicestershire, England.
• Electronic laboratory request forms were redesigned, and vitamin D request data were collected for 6 months pre- and post-intervention.
• Data on vitamin D, calcium, and phosphate levels were also collected to assess clinical impact.

Main Results:

• The intervention resulted in a 36.2% decrease in vitamin D test requests (14,918 fewer tests).
• No clinically significant changes were observed in median calcium and phosphate levels.
• Cost modeling indicated potential annual savings of over £38 million for the NHS if implemented nationwide.

Conclusions:

• A pragmatic redesign of electronic request forms effectively reduced vitamin D test ordering.
• The intervention demonstrated a significant reduction in testing without compromising the quality of patient care.