scholarly journals Reducing vitamin test ordering in primary care; the effectiveness of professional and patient oriented strategies in a Cluster randomized Intervention Study

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0113
Author(s):  
Saskia van Vugt ◽  
Evelien de Schepper ◽  
Sanne van Delft ◽  
Nicolaas Zuithoff ◽  
Niek de Wit ◽  
...  
Keyword(s):  
Primary Care ◽  
Vitamin D ◽  
Vitamin B12 ◽  
Implementation Strategy ◽  
Intervention Study ◽  
National Level ◽  
Relative Reduction ◽  
Intervention Programme ◽  
Health Centres ◽  
Test Ordering

BackgroundVitamin tests are increasingly ordered by GPs, but a clinical and evidence based indication is often lacking. Harnessing technology, ie, decision support tools and redesigning request forms, have been shown to reduce vitamin D requests.AimCould the number of vitamin tests also be reduced by providing a multi-level intervention programme based on training, monitoring and feedback?Design & SettingIn a Cluster Randomised Intervention Study performed in 26 primary care health-centres (200.000 patients) the relative reduction in ordered vitamin D and B12 tests was determined after introduction of two de-implementation strategies (may 2017-may 2018).MethodHealth-centres randomised to de-implementation strategy one received education and 3-monthly benchmarking of their own vitamin test ordering behaviour. Health-centres in de-implementation strategy two received the same education and benchmarking but supplemented with educational material for patients.ResultsThe number of vitamin D tests decreased 23% compared to the one-year pre-intervention period. 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, but only for vitamin D test ordering (10% extra reduction, OR 0.88, 95% CI 0.83–0.92, compared to 4% extra reduction for vitamin B12, OR 0.96, 95% CI 0.91–1.02). Nationwide, this would result in over € 3.200.000 saving on healthcare expenditure per year.ConclusionA 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 can be achieved.

scholarly journals Reducing unnecessary vitamin testing in general practice: barriers and facilitators according to general practitioners and patients

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e029760 ◽  
Author(s):  
H. Hofstede ◽  
H.A.M. van der Burg ◽  
B.C. Mulder ◽  
A.M. Bohnen ◽  
P.J.E. Bindels ◽  
...  
Keyword(s):  
Primary Care ◽  
Vitamin D ◽  
General Practice ◽  
Qualitative Study ◽  
General Practitioners ◽  
Implementation Strategies ◽  
Barriers And Facilitators ◽  
Care Practice ◽  
Registration Number ◽  
Test Ordering

ObjectiveThere 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 B12laboratory tests ordered.Design and settingThis 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.ParticipantsTwenty-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.ResultsThe 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 B12. 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.ConclusionTo 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.Trial registration numberWAG/mb/16/039555.

scholarly journals Intervention to reduce vitamin testing in primary care: a randomized controlled trial

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X703061
Author(s):  
Saskia Van Vugt ◽  
Evelien de Schepper ◽  
Niek De Wit ◽  
Patrick Bindels
Keyword(s):  
Vitamin D ◽  
Vitamin B12 ◽  
Patient Information ◽  
Controlled Trial ◽  
Study Endpoint ◽  
Primary Study ◽  
High Dose ◽  
Intervention Period ◽  
Intervention Programme ◽  
Randomised Study

BackgroundAlthough vitamin tests are increasingly ordered by GPs, an evidence-based indication is often lacking.AimTo rationalise and reduce ordering of vitamin D and B12 tests by educating GPs and their patients about the merits and pitfalls of performing vitamin tests.MethodA two-armed cluster randomised study assessing the effectiveness of two separate interventions on the number of vitamin tests ordered. In total 26 health centres in the Netherlands participated (200 000 patients). De-implementation group 1 received education and a 3-monthly benchmarking of their own vitamin test ordering behaviour. De-implementation group 2 received the same intervention, but supplemented with educational material for patients. The primary study endpoint was the total reduction in vitamin D and B12 tests ordered at the end of the study as compared to a 1-year pre-intervention period. Secondary outcomes were the number of deficient test results, the number of (high dose) vitamin prescriptions, and the direct cost savings.ResultsThe number of vitamin D tests ordered at the end of the 1-year study period as compared to a 1-year pre-intervention period decreased with 23%. For vitamin B12 tests an overall reduction of 20% was found. Adding patient information had additional value over training and benchmarking of GPs, which was significant for vitamin D (−29% with and −19% without patient information), compared to respectively −22% and −18% for vitamin B12.ConclusionA structured intervention programme, including training of GPs and benchmarking their ordering of diagnostic tests, resulted in a significant reduction in ordered vitamin tests.

scholarly journals The prevalence of low serum levels of Vitamin D, Vitamin B12, folate and ferritin in adolescents: Single center experience

2021 ◽  
Vol 104 (2) ◽  
pp. 003685042110076
Author(s):  
Nazmi Mutlu Karakaş
Keyword(s):  
Vitamin D ◽  
Vitamin B12 ◽  
Medical Records ◽  
Vitamin B12 Deficiency ◽  
Serum Levels ◽  
Folate Deficiency ◽  
Well Child Care ◽  
Single Center Experience ◽  
B12 Deficiency ◽  
Prevalence Of Anemia

Background: In this study, the aim was to evaluate the prevalence of vitamin D, vitamin B12, ferritin, and folate deficiencies in adolescence to clarify the need for early diagnosis and therapy. Methods: The medical records of adolescents between 10 and 18 years of age between 01 September 2018 and 28 February 2019 as healthy with non-specific complaints, or due to well-child care visits, were analyzed retrospectively. Results: A total of 1847/2507 (73.6%) adolescents were included in the study. The prevalence of vitamin D deficiency was 25.7% (n: 178/691). Vitamin B12 deficiency prevalence was 69.2% (n: 753/1088). The prevalence of anemia and ferritin deficiency was 4.8% and 13.26%. The prevalence of folate deficiency was 37.9% (n: 413/1088). VDD prevalence was statistically significantly higher in females than males (F/M:116/62). VB12D prevalence, the number and mean age of females with hemoglobin deficiency, and low ferritin levels was found to be statistically significantly higher in females than males. Conclusions: The prevalence of vitamin D, vitamin B12, folate deficiency and low ferritin levels was found to be high among adolescents. In particular, adolescents admitting with non-specific complaints and for control purposes in big cities must be considered to be at risk for the deficiency of these vitamins and low level of ferritin.

scholarly journals Effectiveness of two procedures for deploying a facilitated collaborative modeling implementation strategy—the PVS-PREDIAPS strategy—to optimize type 2 diabetes prevention in primary care: the PREDIAPS cluster randomized hybrid type II implementation trial

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Alvaro Sanchez ◽  
◽  
Susana Pablo ◽  
Arturo Garcia-Alvarez ◽  
Silvia Dominguez ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Diabetes Prevention ◽  
Implementation Strategy ◽  
Type Ii ◽  
Collaborative Process ◽  
Type 2 Diabetes Prevention ◽  
Cluster Randomized ◽  
Implementation Trial

Abstract Background The most efficient procedures to engage and guide healthcare professionals in collaborative processes that seek to optimize practice are unknown. The PREDIAPS project aims to assess the effectiveness and feasibility of different procedures to perform a facilitated interprofessional collaborative process to optimize type 2 diabetes prevention in routine primary care. Methods A type II hybrid cluster randomized implementation trial was conducted in nine primary care centers of the Basque Health Service. All centers received training on effective healthy lifestyle promotion. Headed by a local leader and an external facilitator, centers conducted a collaborative structured process—the PVS-PREDIAPS implementation strategy—to adapt the intervention and its implementation to their specific context. The centers were randomly allocated to one of two groups: one group applied the implementation strategy globally, promoting the cooperation of all health professionals from the beginning, and the other performed it sequentially, centered first on nurses, who later sought the pragmatic cooperation of physicians. The following patients were eligible for inclusion: all those aged ≥ 30 years old with at least one known cardiovascular risk factor and an impaired fasting glucose level (≥ 110-125 mg/dl) but without diabetes who attended centers during the study period. The main outcome measures concerned changes in type 2 diabetes prevention practice indicators after 12 months. Results After 12 months, 3273 eligible patients at risk of type 2 diabetes had attended their family physician at least once, and of these, 490 (15%) have been addressed by assessing their healthy lifestyles in both comparison groups. The proportion of at-risk patients receiving a personalized prescription of lifestyle change was slightly higher (8.6%; range 13.5-5.9% vs 6.8%; range 7.2-5.8%) and 2.3 times more likely (95% CI for adjusted hazard ratio, 1.38-3.94) in the sequential than in the global centers, after 8 months of the intervention program implementation period. The probability of meeting the recommended levels of physical activity and fruit and vegetable intake were four- and threefold higher after the prescription of lifestyle change than only assessment and provision of advice. The procedure of engagement in and execution of the implementation strategy does not modify the effect of prescribing healthy habits (p interaction component of intervention by group, p > 0.05). Discussion Our results show that the PVS-PREDIAPS implementation strategy manages to integrate interventions with proven efficacy in the prevention of type 2 diabetes in clinical practice in primary care. Further, they suggest that implementation outcomes were somewhat better with a sequential facilitated collaborative process focused on enhancing the autonomy and responsibility of nurses who subsequently seek a pragmatic cooperation of GPs. Trial registration Clinicaltrials.gov identifier: NCT03254979. Registered 16 August 2017—retrospectively registered.

scholarly journals Improving mobility and participation of older people with vertigo, dizziness and balance disorders in primary care using a care pathway: feasibility study and process evaluation

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Eva Seckler ◽  
Verena Regauer ◽  
Melanie Krüger ◽  
Anna Gabriel ◽  
Joachim Hermsdörfer ◽  
...  
Keyword(s):  
Primary Care ◽  
Data Collection ◽  
Older People ◽  
Process Evaluation ◽  
Feasibility Study ◽  
Health Professionals ◽  
Implementation Strategy ◽  
Care Pathway ◽  
Main Trial ◽  
Telephone Helpline

Abstract Background Community-dwelling older people are frequently affected by vertigo, dizziness and balance disorders (VDB). We previously developed a care pathway (CPW) to improve their mobility and participation by offering standardized approaches for general practitioners (GPs) and physical therapists (PTs). We aimed to assess the feasibility of the intervention, its implementation strategy and the study procedures in preparation for the subsequent main trial. Methods This 12-week prospective cohort feasibility study was accompanied by a process evaluation designed according to the UK Medical Research Council’s Guidance for developing and evaluating complex interventions. Patients with VDB (≥65 years), GPs and PTs in primary care were included. The intervention consisted of a diagnostic screening checklist for GPs and a guide for PTs. The implementation strategy included specific educational trainings and a telephone helpline. Data for mixed-method process evaluation were collected via standardized questionnaires, field notes and qualitative interviews. Quantitative data were analysed using descriptive statistics, qualitative data using content analysis. Results A total of five GP practices (seven single GPs), 10 PT practices and 22 patients were included in the study. The recruitment of GPs and patients was challenging (response rates: GP practices: 28%, PT practices: 39%). Ninety-one percent of the patients and all health professionals completed the study. The health professionals responded well to the educational trainings; the utilization of the telephone helpline was low (one call each from GPs and PTs). Familiarisation with the routine of application of the intervention and positive attitudes were emphasized as facilitators of the implementation of the intervention, whereas a lack of time was mentioned as a barrier. Despite difficulties in the GPs’ adherence to the intervention protocol, the GPs, PTs and patients saw benefit in the intervention. The patients’ treatment adherence to physical therapy was good. There were minor issues in data collection, but no unintended consequences. Conclusion Although the process evaluation provided good support for the feasibility of study procedures, the intervention and its implementation strategy, we identified a need for improvement in recruitment of participants, the GP intervention part and the data collection procedures. The findings will inform the main trial to test the interventions effectiveness in a cluster RCT. Trial registration Projektdatenbank Versorgungsforschung Deutschland (German registry Health Services Research) VfD_MobilE-PHY_17_003910, date of registration: 30.11.2017; Deutsches Register Klinischer Studien (German Clinical Trials Register) DRKS00022918, date of registration: 03.09.2020 (retrospectively registered).

scholarly journals Vitamin Intake and Loss of Muscle Mass in Older People with Type 2 Diabetes: A Prospective Study of the KAMOGAWA-DM Cohort

Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2335
Author(s):  
Fuyuko Takahashi ◽  
Yoshitaka Hashimoto ◽  
Ayumi Kaji ◽  
Ryosuke Sakai ◽  
Yuka Kawate ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Vitamin D ◽  
Older People ◽  
Vitamin B12 ◽  
Muscle Mass ◽  
Vitamin B1 ◽  
Vitamin D Intake ◽  
Glucagon Like Peptide 1

The aim of this prospective cohort study was to examine the relationships between the intakes of various vitamins and the loss of muscle mass in older people with type 2 diabetes (T2DM). The change in skeletal muscle mass index (SMI, kg/m2) (kg/m2/year) was defined as follows: (SMI at baseline (kg/m2) − SMI at follow-up (kg/m2))/follow-up period (year). The rate of SMI reduction (%) was calculated as follows (the change in SMI (kg/m2/year)/SMI at baseline (kg/m2)) × 100. The rate of SMI reduction ≥ 1.2% was considered as the loss of muscle mass. Among 197 people with T2DM, 47.2% of them experienced the loss of muscle mass at the 13.7 ± 5.2 month follow-up. Vitamin B1 (0.8 ± 0.3 vs. 0.8 ± 0.3 mg/day, p = 0.031), vitamin B12 (11.2 ± 8.3 vs. 13.4 ± 7.5 μg/day, p = 0.049), and vitamin D (16.5 ± 12.2 vs. 21.6 ± 13.0 μg/day, p = 0.004) intakes in people with the loss of muscle mass were significantly lower than those without. Vitamin D intake was related to the loss of muscle mass after adjusting for sex, age, exercise, alcohol, smoking, body mass index, SMI, glucagon-like peptide-1 agonist, sodium glucose cotransporter-2 inhibitor, insulin, HbA1c, creatinine, energy intake, and protein intake (adjusted odds ratio 0.93, 95% confidence interval: 0.88–0.97, p = 0.003). This study showed that vitamin D intake was related to the loss of muscle mass in older people with T2DM. Vitamin B12 intake tended to be related to the loss of muscle mass, although vitamin A, vitamin B2, vitamin B6, vitamin C, and vitamin E intake were not related.

scholarly journals Evaluation of the Relationship Between Serum levels of Zinc, Vitamin B12, Vitamin D and Clinical outcomes in Patients with COVID‐19

2021 ◽  
Author(s):  
Habibesadat Shakeri ◽  
Amir Azimian ◽  
Hamed Ghasemzadeh‐Moghaddam ◽  
Mohammadreza Safdari ◽  
Mehdi Haresabadi ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin B12 ◽  
Clinical Outcomes ◽  
Serum Levels ◽  
The Relationship

scholarly journals Increased vitamin D binding protein levels are associated with irritable bowel syndrome

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Elif Börekci ◽  
Mahmut Kılıç ◽  
Zeynep Ozan ◽  
Hasan Börekci ◽  
Tekin Yıldırım ◽  
...  
Keyword(s):  
Vitamin D ◽  
Logistic Regression ◽  
Irritable Bowel Syndrome ◽  
Regression Analysis ◽  
Vitamin B12 ◽  
Logistic Regression Analysis ◽  
Binding Protein ◽  
Serum Levels ◽  
Vitamin D Binding Protein ◽  
Irritable Bowel

Abstract Objectives There is no reliable and valid biomarker to identify Irritable bowel syndrome (IBS) and its subtypes. The aim of this study is to explore potential serum biomarkers that may be associated with IBS subtypes, particularly in the vitamin D pathway. Methods The study population comprised 75 IBS patients and 79 controls. Patients divided into IBS subtypes. Routine biochemical parameters, 25-OH-vitamin D, vitamin D binding protein (VDBP) and vitamin D receptor (VDR) serum levels were compared between IBS subtypes and controls. Factors related to IBS subtypes were examined by multivariate logistic regression analysis. Results Vitamin D levels were lower; VDBP and VDR were higher in all IBS patients than in controls (p<0.001; 0.047 and 0.029, respectively). According to logistic regression analysis, VDBP was a disease-related parameter as much as vitamin D in all IBS subtypes. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were higher especially in diarrhea-dominant IBS (IBS-D) (p=0.041; 0.046) and vitamin B12 were significantly lower in constipation-dominant IBS (IBS-C) (p=0.001). Conclusions Increased VDBP levels were associated with all IBS subtypes. Patients, especially in IBS-D, had higher serum levels of VDBP, CRP and ESR. Vitamin B12 deficiency, which we consider as a result of the disease, was more common in IBS-C.

scholarly journals Evaluating the integration of palliative care in national health systems: an indicator rating process with EAPC task force members to measure advanced palliative care development

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Natalia Arias-Casais ◽  
Eduardo Garralda ◽  
Miguel Antonio Sánchez-Cárdenas ◽  
John Y. Rhee ◽  
Carlos Centeno
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Long Term Care ◽  
Task Force ◽  
National Level ◽  
Structured Interviews ◽  
Term Care ◽  
Care Facilities ◽  
Rating Process

Abstract Background Palliative care (PC) development cannot only be assessed from a specialized provision perspective. Recently, PC integration into other health systems has been identified as a component of specialized development. Yet, there is a lack of indicators to assess PC integration for pediatrics, long-term care facilities, primary care, volunteering and cardiology. Aim To identify and design indicators capable of exploring national-level integration of PC into the areas mentioned above. Methods A process composed of a desk literature review, consultation and semi-structured interviews with EAPC task force members and a rating process was performed to create a list of indicators for the assessment of PC integration into pediatrics, long-term care facilities, primary care, cardiology, and volunteering. The new indicators were mapped onto the four domains of the WHO Public Health Strategy. Results The literature review identified experts with whom 11 semi-structured interviews were conducted. A total of 34 new indicators were identified for national-level monitoring of palliative care integration. Ten were for pediatrics, five for primary care, six for long-term care facilities, seven for volunteering, and six for cardiology. All indicators mapped onto the WHO domains of policy and education while only pediatrics had an indicator that mapped onto the domain of services. No indicators mapped onto the domain of use of medicines. Conclusion Meaningful contributions are being made in Europe towards the integration of PC into the explored fields. These efforts should be assessed in future regional mapping studies using indicators to deliver a more complete picture of PC development.

scholarly journals Incidence and risk factors of micronutrient deficiency in patients with IBD and intestinal Behçet’s disease: folate, vitamin B12, 25-OH-vitamin D, and ferritin

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yong Eun Park ◽  
Soo Jung Park ◽  
Jae Jun Park ◽  
Jae Hee Cheon ◽  
TaeIl Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Vitamin B12 ◽  
Behcet’S Disease ◽  
Micronutrient Deficiency ◽  
Intestinal Behçet’S Disease ◽  
Intestinal Behcet’S Disease ◽  
25 Oh Vitamin D ◽  
Deficiency Group ◽  
Intestinal Behçet's Disease

Abstract Background Patients with inflammatory bowel disease (IBD) and intestinal Behçet’s disease (BD) are vulnerable to micronutrient deficiencies due to diarrhea-related gastrointestinal loss and poor dietary intake caused by disease-related anorexia. However, few studies have investigated the incidence and risk factors for micronutrient deficiency. Methods We retrospectively analyzed 205 patients with IBD who underwent micronutrient examination, including folate, vitamin B12, 25-OH-vitamin D, and/or ferritin level quantification, with follow-up blood tests conducted 6 months later. Results Eighty patients (39.0%), who were deficient in any of the four micronutrients, were classified as the deficiency group, and the remaining 125 (61.0%) were classified as the non-deficient group. Compared to those in the non-deficiency group, patients in the deficiency group were much younger, had more Crohn's disease (CD) patients, more patients with a history of bowel operation, and significantly less 5-amino salicylic acid usage. Multivariate analysis revealed that CD and bowel operation were significant independent factors associated with micronutrient deficiency. Conclusions The incidence of micronutrient deficiency was high (39.0%). Factors including CD, bowel operation, and younger ages were found to be associated with higher risks of deficiency. Therefore, patients with IBD, especially young patients with CD who have undergone bowel resection surgery, need more attention paid to micronutrition.

Sign in / Sign up

Export Citation Format

Share Document