Article type
Abstract
Introduction: The Lab Director of the Navarre Health Service (Spain) reported a steady increase in vitamin D testing orders over the last few years suggesting overuse. A report was made that identified seven Cochrane reviews along with some other non-Cochrane reviews on this topic. Report recommendations on vitamin D testing were disseminated to all healthcare professionals in the province. Additionally, e-Health Record (e-HR) warnings based on the report recommendations were implemented for hospital doctors only, due to technical issues in the family doctors’ e-HR. Five years afterwards, e-HR warnings were also implemented for family doctors.
Objective: To assess the impact of the implementation of e-HR warnings on doctors’ ordering of vitamin D testing.
Methods: The number of vitamin D orders per 100 person-years pre- and post-intervention were analyzed separately for hospital and family doctors. Differences in absolute and relative terms are shown.
Results: After the intervention (November 2018), test orders from hospital doctors dropped from 4.37 in 2018 to 3.05 per 100 person-years in 2023, RR 0.70 (0.69 to 0.71). This drop took place mainly within the first year and, leaving aside 2020 (due to the pandemic), testing figures were maintained over the following three years. Conversely, family doctors had no warning implemented in their e-HR before 2023, and test orders increased from 3.32 in 2018 to 6.65 per 100 person-years in 2022, RR 2.00 (1.97 to 2.03). In February 2023, e-HR warnings were definitely implemented for family doctors. Test orders decreased from 6.65 to 5.10 per 100 person-years (2022 vs 2023, respectively), RR 0.77 (0.76 to 0.78), showing a turning point in the previous increasing trend, along with a significant decrease within the first year after the intervention.
Conclusion: Evidence-based e-HR warnings on the use of vitamin D testing might result useful in improving appropriate use of this test in clinical practice.
Objective: To assess the impact of the implementation of e-HR warnings on doctors’ ordering of vitamin D testing.
Methods: The number of vitamin D orders per 100 person-years pre- and post-intervention were analyzed separately for hospital and family doctors. Differences in absolute and relative terms are shown.
Results: After the intervention (November 2018), test orders from hospital doctors dropped from 4.37 in 2018 to 3.05 per 100 person-years in 2023, RR 0.70 (0.69 to 0.71). This drop took place mainly within the first year and, leaving aside 2020 (due to the pandemic), testing figures were maintained over the following three years. Conversely, family doctors had no warning implemented in their e-HR before 2023, and test orders increased from 3.32 in 2018 to 6.65 per 100 person-years in 2022, RR 2.00 (1.97 to 2.03). In February 2023, e-HR warnings were definitely implemented for family doctors. Test orders decreased from 6.65 to 5.10 per 100 person-years (2022 vs 2023, respectively), RR 0.77 (0.76 to 0.78), showing a turning point in the previous increasing trend, along with a significant decrease within the first year after the intervention.
Conclusion: Evidence-based e-HR warnings on the use of vitamin D testing might result useful in improving appropriate use of this test in clinical practice.