Reducing unnecessary vitamin testing in general practice: barriers and facilitators according to general practitioners and patients
Reducing unnecessary vitamin testing in general practice: barriers and facilitators according to general practitioners and patients
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DOI：
10.1136/bmjopen-2019-029760
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发表时间：
2019-10-01
期刊：
影响因子：
2.9
通讯作者：
van Vugt, S. F.
中科院分区：
文献类型：
--
作者：
Hofstede, H.;van der Burg, H. A. M.;van Vugt, S. F.
目的 在一般实践中，对患者的维生素检测有所增加，通常是基于不合理的适应症或非特异性症状，导致患者的医疗保健支出和医疗费用增加。到目前为止，几乎没有证据表明在一般实践中可以采取有效的策略来减少这种过度测试。因此，这项定性研究的目的是探讨减少（不必要的）维生素 D 和 B-12 实验室测试数量的障碍和促进因素。 设计和设置 这项定性研究基于扎根理论设计，对全科医生 (GP) 和来自两个初级保健网络的患者（147 名全科医生，195 000 名患者）进行了半结构化访谈。这些网络参与了减少初级保健实践中的维生素测试 (REVERT) 研究，这是一项集群随机试验，比较了荷兰初级保健中减少测试顺序的两种取消实施策略。 参与者 招募了 21 名全科医生（每个诊所最多 1 名全科医生）参加了 REVERT 研究，以及 22 名患者（在维生素相关咨询期间受到全科医生的邀请），其中 20 名全科医生和 19 名患者同意结果 阻碍维生素测试减少计划的最重要因素是患者和医疗专业人员之间对于维生素 D 和 B-12 测试的假定适当适应症的不匹配。相比之下，减少维生素测试的最重要的促进因素可能是更新全科医生关于测试适应症的知识以及他们对自己测试行为的认识。结论为了实现维生素测试的可持续减少，需要针对维生素测试的循证适应症提供明确和统一的建议的指南，并结合对测试排序行为的定期（个人）反馈。此外，公众需要获得有关维生素检测的清晰可靠的信息。需要进一步的研究来衡量这些策略对维生素测试请求数量的影响。
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 vitamintest 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.