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Temporal and regional variability in the request of vitamin D from general practitioners in Spain

  • Maria Salinas EMAIL logo , Maite López-Garrigós , Emilio Flores , Carlos Leiva-Salinas and on behalf of the Pilot Group of the Appropriate Utilization of Laboratory Tests (REDCONLAB) working group
Published/Copyright: February 23, 2017
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 55 Issue 11

Abstract

Background:

Our main goal is to study the inter-practice regional variability and the temporal evolution in the request of 25-hydroxyvitamin D (25[OH]D) by general practitioners (GPs) in Spain.

Methods:

Clinical laboratories in different autonomic communities (AACCs) were invited to report the number of 25(OH)D test requested by GPs during 2012 and 2014. The number of 25(OH)D requested per 1000 inhabitants and the index of variability were calculated, and compared between regions and time periods. We calculated the number of tests that could have been potentially saved in regions where 25(OH)D could be requested from primary care without restrictions taking into account the request in those where it is restricted, and the potential economical savings.

Results:

Seventy-six laboratories participated in the 2012 edition, and 110 in 2014, corresponding to 17,679,195 and 27,798,262 inhabitants (59.8% Spanish population). The number of 25(OH)D requested per 1000 inhabitants increased from 1.1 in 2012 to 3.4 in 2014 (p<0.001). The variability index also increased from 51.7 to 68. There was a significantly variability among the different AACCs, ranging from 0.94 to 21.24 (p=0.002). 173,885 tests could have been not measured from primary care in regions without ordering restrictions, resulting in potential 886,813.5€ savings.

Conclusions:

There was a high variability in the request of 25(OH)D by GPs in Spain, which significantly increased in a 2 year period. The demand was higher in areas where the request of 25(OH)D was not restricted in primary care, with potential savings if the request would approach to regions with ordering restrictions.

Keywords: appropriateness; demand management; primary care; vitamin D
Corresponding author: Dr. Maria Salinas, Clinical Laboratory, Hospital Universitario de San Juan, Carretera Alicante-Valencia, s/n, 03550 San Juan de Alicante, Alicante, Spain, Phone: +34-965938877, Fax: +34-965938383

Acknowledgments

Members of the REDCONLAB working group are the following: Vidal Perez Valero [Hospital Regional Universitario de Malaga, Hospital Universitario Virgen de la Victoria (Málaga)]; Félix Gascón (Hospital Valle de los Pedroches, Pozoblanco); Isidoro Herrera Contreras (Complejo Hospitalario de Jaen); Maria Angeles Bailen Garcia (Hospital Universitario Puerta del Mar de Cadiz); Cristobal Avivar Oyonarte (Hospital de Poniente, El Ejido); Esther Roldán Fontana (Hospital La Merced); Fernando Rodriguez Cantalejo (Hospital Universitario Reina Sofia de Cordoba); Jose Angel Noval Padillo (Hospital Universitario Virgen del Rocio); M Angela Gonzalez García (AGS Norte de Cadiz); Ignacio Vazquez Rico (Hospital Juan Ramon Jimenez de Huelva); Cristina Santos (Hospital Rio Tinto); Angeles Giménez Marín (Hospital de Antequera); Maria del Señor López-Vélez, José Vicente Garcia Lario (Hospital San Cecilio de Granada, Hospital Virgen de las Nieves, Granada); Federico Navajas Luque (AGS Este de Málaga-Axarquía); Amado Tapia (Hospital de Barbastro); Maria Esther Sole LLop (Hospital de Alcañiz); Juan José Puente (Hospital Clínico Universitario Lozano Blesa); Patricia Esteve (Hospital Ernest Lluch); Maria Teresa Avello Lopez (Hospital San Agustín-Aviles, Hospital Valle del Nalon); Emilia Moreno Noguero (Hospital Can MIsses); Ana Maria Follana Vazquez (Hospital Mateu Orfila); Jose Luis Ribes Valles (Hospital de Manacor); Ma Luisa Fernández de Lis Alonso (Area de Salud de Fuerteventura); MC Martin-Fernández de Basoa (Hospital Nuestra Señora de la Candelaria, Tenerife); Leopoldo Martin Martin (Hospital General de la Palma); Miguel Angel Pico Picos (Hospital Universitario de Canarias); Casimira Dominguez Cabrera (Hospital Universitario de Gran Canaria Dr Negrín); Marta Riaño Ruiz (Hospital Insular de Gran Canaria); Juan Ignacio Molinos (Hospital Sierrallana de Torrelavega); Luis Fernando Colomo (Hospital de Laredo); José Carlos Garrido (Hospital Universitario Marques de Valdecilla); Enrique Prada de Medio (Hospital Virgen de la Luz de Cuenca); Pilar Garcia Chico (Hospital General Universitario de Ciudad Real); Simon Gomez-Biedma (Hospital General de Almansa); Jesús Domínguez (Hospital Universitario de Guadalajara); Guadalupe Ruiz (Complejo Hospitalario de Toledo); Laura Navarro Casado (Complejo Hospitalario Universitario de Albacete); Fidel Velasco Pena (Hospital Virgen de Altagracia, Manzanares); Carolina Andrés Fernandez (Hospital General de Villarobledo); Ma Carmen Lorenzo Lozano (Hospital de Puertollano); Joaquín Domínguez Martinez y Oscar Herrera Carrera (Hospital General Mancha Centro y Hospital General de Tomelloso); Maria Teresa Gil (Hospital Nuestra Señora del Prado Talavera de la Reina); Ma Angeles Rodriguez Rodriguez (Complejo Asistencial Universitario de Palencia (Hospital Rio Carrion)); M. Victoria Poncela Garcia (Hospital Universitario de Burgos); Luis Rabadan (Complejo Asistencial de Soria); Vicente Villamandos (Hospital Santos Reyes, Aranda del Duero); Nuria Fernandez Garcia (Hospital Universitario Rio Hortega-Valladolid); Jose Miguel Gonzalez Redondo (Hospital Santiago Apostol de Miranda de Ebro); Cesareo Garcia (Hospital Universitario de Salamanca); Luis Garcia Menendez (Hospital El Bierzo); Pilar Alvarez Sastre (Complejo Asistencial de Zamora); Ovidio Gomez (Hospital Cínico Universitario de Valladolid); Mabel LLovet [Hospital Universitario Verge de la Cinta (Tortosa)]; Nuria Serrat (Hospital Joan XXIII de Tarragona); Ma José Baz (Hospital de Llerena, Badajoz); Maria Jose Zaro (Hospital Don Benito-Villanueva); M Carmen Plata (Hospital Campo Arañuelo, Navalmoral de la Mata); Pura Garcia Yun [Área de Salud de Badajoz (Hospital Infanta Cristina, Hospital Perpetuo Socorro y Hospital Materno Infantil)]; Milagrosa Macías Sánchez [Area de Salud de Caceres (Complejo Hospitalario San Pedro de Alcantara)]; Javier Martin (Hospital Virgen del Puerto de Plasencia); Lola Máiz Suarez (Hospital Lucus Augusti, Lugo); Berta Gonzalez Ponce (Hospital Da Costa, Burela); Aida Pérez Fuertes (Hospital Arquitecto Marcide, El Ferrol); M. Amalia Andrade Olivie (Hospital Xeral-Cies, CHU Vigo); Pastora Rodriguez (Hospital Universitario de A Coruña); M. Mercedes Herranz Puebla (Hospital General Universitario Gregorio Marañon); Antonio Buño Soto (Hospital Universitario La Paz, Madrid); Fernando Cava, Raquel Guillen Santos (BR Salud); Tomas Pascual (Hospital Universitario de Getafe); Carmen Hernando de Larramendi (Hospital Severo Ochoa de Leganes); Raquel Blázquez Sánchez (Hospital de Mostoles); Pilar Díaz (Hospital 12 de Octubre, Madrid); Ana Díaz (Hospital Universitario de La Princesa); Marta Garcia Collia (Hospital Ramon y Cajal, Madrid); Maria Angeles Cuadrado Cenzual (Hospital Clinico Universitario San Carlos); Santiago Prieto Menchero (Hospital Universitario de Fuenlabrada); María del Carmen Gallego Ramírez (Hospital Rafael Mendez, Lorca); Jose Luis Quilez Fernandez (Hospital Universitario Reina Sofia de Murcia); Maria Dolores Albaladejo (Hospital Santa Lucia, Cartagena); Maria Luisa Lopez Yepes (Hospital Virgen del Castillo de Yecla); Alfonso Pérez Martínez (Hospital Morales Meseguer); Antonio López Urrutia (Hospital de Cruces, Bilbao); Adolfo Garrido Chércoles (Hospital Universitario de Donostia); Carmen Mar Medina (Hospital Galdakao-Usonsolo); M Carmen Zugaza (Unidad de Gestion Clinica de Alava); Francisco Javier Aguayo Gredilla (Hospital Universitario de Basurto); Silvia Pesudo (Hospital La Plana); Carmen Vinuesa (Hospital de Vinaros); Julian Díaz (Hospital Francesc de Borja, Gandia); Marisa Graells (Hospital General Universitario de Alicante); Diego Benitez Benitez (Hospital de Orihuela); Arturo Carratala (Hospital Clinico Universitario de Valencia); Consuelo Tormo (Hospital General de Elche); Francisco Miralles (Hospital Lluis Alcanyis, Xativa); Amparo Miralles (Hospital de Sagunto); Jose Luis Barberà (Hospital de Manises); Juan Molina (Hospital Comarcal de La Marina, Villajoyosa); Martin Yago (Hospital de Requena); Mario Ortuño [Hospital Universitario de la Ribera (Alzira)]; Maria Jose Martinez Llopis (Hospital de Denia); Nuria Estañ (Hospital Dr. Peset); Ricardo Molina (Hospital Virgen de los Lirios, Alcoy); Juan Antonio Ferrero (Hospital General de Castellon); Begoña Laiz Marro (Hospital Universitario y Politecnico La Fe de Valencia); Goitzane Marcaida (Consorcio Hospital General Universitario de Valencia).

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Received: 2016-11-11
Accepted: 2016-12-27
Published Online: 2017-2-23
Published in Print: 2017-10-26

©2017 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/cclm-2016-1040
Keywords for this article
appropriateness; demand management; primary care; vitamin D

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. High-sensitivity assays for cardiac troponins – continued
  4. Reviews
  5. The 99th percentile of reference population for cTnI and cTnT assay: methodology, pathophysiology and clinical implications
  6. Vitamin B1 in critically ill patients: needs and challenges
  7. Opinion Papers
  8. Point
  9. High-sensitivity cardiac troponin: do think twice, it’s not all right
  10. Counterpoint
  11. Terminology of cardiac troponin assays and data censoring
  12. Establishing consensus-based, assay-specific 99th percentile upper reference limits to facilitate proper utilization of cardiac troponin measurements
  13. Fast track protocols using highly sensitive troponin assays for ruling out and ruling in non-ST elevation acute coronary syndrome
  14. Genetics and Molecular Diagnostics
  15. Relationship between polymorphisms in the CRP, LEP and LEPR genes and high sensitivity C-reactive protein levels in Spanish children
  16. General Clinical Chemistry and Laboratory Medicine
  17. An approach for estimating measurement uncertainty in medical laboratories using data from long-term quality control and external quality assessment schemes
  18. Selecting multi-rule quality control procedures based on patient risk
  19. Moving sum of number of positive patient result as a quality control tool
  20. Multidisciplinary training activities for decreasing preanalytical mistakes in samples from primary care
  21. Harmonization protocols for TSH immunoassays: a multicenter study in Italy
  22. Circulating free light chain measurement in the diagnosis, prognostic assessment and evaluation of response of AL amyloidosis: comparison of Freelite and N latex FLC assays
  23. Serum prolactin revisited: parametric reference intervals and cross platform evaluation of polyethylene glycol precipitation-based methods for discrimination between hyperprolactinemia and macroprolactinemia
  24. Temporal and regional variability in the request of vitamin D from general practitioners in Spain
  25. Fibrinogen determination according to Clauss: commutability assessment of International and commercial standards and quality control samples
  26. Reference Values and Biological Variations
  27. S100B maternal blood levels are gestational age- and gender-dependent in healthy pregnancies
  28. Gestational age-specific reference intervals for serum thyroid hormone levels in a multi-ethnic population
  29. Cancer Diagnostics
  30. Serum complexed and free prostate-specific antigen (PSA) for the diagnosis of the polycystic ovarian syndrome (PCOS)
  31. Cardiovascular Diseases
  32. A new immunochemistry platform for a guideline-compliant cardiac troponin T assay at the point of care: proof of principle
  33. Diabetes
  34. Adiponectin and leptin as first trimester markers for gestational diabetes mellitus: a cohort study
  35. Letters to the Editor
  36. Can we still trust hemoglobin A1c in all situations?
  37. Automated detection of unstable hemoglobin variants by Sysmex XE-Series analyzers
  38. Mean hemoglobin concentrations in fasting venous and non-fasting capillary blood of Cambodian women using a hemoglobinometer and an automated hematology analyzer
  39. Evaluation of a POCT device for C-reactive protein, hematocrit and leukocyte differential
  40. New perspectives on existing data in comparative measurements: a simple extension of the regression analysis
  41. Evaluation of a human anti-mouse antibody rapid test for patients requiring radio-immunodiagnostic
  42. The cortisol-CBG ratio affects cortisol immunoassay bias at elevated CBG concentrations
  43. Prognostic value of total antioxidant capacity to predict functional outcome in traumatic brain injury patients
  44. Use of IFCC guidelines to verify acetylcholinesterase reference interval in adults determined with ChE check mobile testing system
  45. Congress Abstracts
  46. 49th National Congress of the Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC – Laboratory Medicine)
  47. Congress of Clinical Chemistry and Laboratory Medicine
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