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Reducing unnecessary vitamin testing in general practice: barriers and facilitators according to general practitioners and patients
OBJECTIVE: There 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 red...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6797438/ https://www.ncbi.nlm.nih.gov/pubmed/31594878 http://dx.doi.org/10.1136/bmjopen-2019-029760 |
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author | Hofstede, H. van der Burg, H.A.M. Mulder, B.C. Bohnen, A.M. Bindels, P.J.E. de Wit, N.J. de Schepper, E.I.T. van Vugt, S.F. |
author_facet | Hofstede, H. van der Burg, H.A.M. Mulder, B.C. Bohnen, A.M. Bindels, P.J.E. de Wit, N.J. de Schepper, E.I.T. van Vugt, S.F. |
author_sort | Hofstede, H. |
collection | PubMed |
description | OBJECTIVE: There 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 B(12) laboratory tests ordered. DESIGN AND SETTING: This 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. PARTICIPANTS: Twenty-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. RESULTS: The 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 B(12). 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. CONCLUSION: To 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 NUMBER: WAG/mb/16/039555. |
format | Online Article Text |
id | pubmed-6797438 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-67974382019-11-01 Reducing unnecessary vitamin testing in general practice: barriers and facilitators according to general practitioners and patients Hofstede, H. van der Burg, H.A.M. Mulder, B.C. Bohnen, A.M. Bindels, P.J.E. de Wit, N.J. de Schepper, E.I.T. van Vugt, S.F. BMJ Open General practice / Family practice OBJECTIVE: There 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 B(12) laboratory tests ordered. DESIGN AND SETTING: This 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. PARTICIPANTS: Twenty-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. RESULTS: The 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 B(12). 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. CONCLUSION: To 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 NUMBER: WAG/mb/16/039555. BMJ Publishing Group 2019-10-07 /pmc/articles/PMC6797438/ /pubmed/31594878 http://dx.doi.org/10.1136/bmjopen-2019-029760 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | General practice / Family practice Hofstede, H. van der Burg, H.A.M. Mulder, B.C. Bohnen, A.M. Bindels, P.J.E. de Wit, N.J. de Schepper, E.I.T. van Vugt, S.F. Reducing unnecessary vitamin testing in general practice: barriers and facilitators according to general practitioners and patients |
title | Reducing unnecessary vitamin testing in general practice: barriers and facilitators according to general practitioners and patients |
title_full | Reducing unnecessary vitamin testing in general practice: barriers and facilitators according to general practitioners and patients |
title_fullStr | Reducing unnecessary vitamin testing in general practice: barriers and facilitators according to general practitioners and patients |
title_full_unstemmed | Reducing unnecessary vitamin testing in general practice: barriers and facilitators according to general practitioners and patients |
title_short | Reducing unnecessary vitamin testing in general practice: barriers and facilitators according to general practitioners and patients |
title_sort | reducing unnecessary vitamin testing in general practice: barriers and facilitators according to general practitioners and patients |
topic | General practice / Family practice |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6797438/ https://www.ncbi.nlm.nih.gov/pubmed/31594878 http://dx.doi.org/10.1136/bmjopen-2019-029760 |
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