Results from a recent study describing evidence of an inconsistency in care, opportunities to improve care, and low-value service cascade following a nonindicated vitamin D test may inform clinicians about the identification and treatment of vitamin D-related abnormalities (J Am Board Fam Med. 2020;33[4]:569-579. doi:10.3122/jabfm.2020.04.200007).
Despite controversy among vitamin D research and clinical guidelines, vitamin D testing and prescribing have increased exponentially in the past 15 years with nonindicated testing representing a portion of the testing. Nonindicated testing is considered low value care and contributes to unnecessary health care spending in the US.
“The purpose of this study was to describe patterns of vitamin D testing within primary care of a large regional health system and to explore downstream health service utilization subsequent to nonindicated testing,” wrote the study authors.
During the study, vitamin D testing records from 2015 were obtained by an electronic health record-automated search. Nonindicated testing was identified as vitamin D tests that do not meet the indictors for testing. Vitamin D-related laboratory testing, imaging services, and prescriptions given during the 24 months following the index vitamin D test were tracked.
Of the 77,836 patients identified, vitamin D tests were conducted on 8042 of these patients with 574 being nonindicated tests. The nonindicated vitamin D test subset showed 39.5% having abnormal test results compared to 24.3% with indicated tests (P <.001).
No follow-up vitamin D testing was conducted in 61.7% of patients with abnormal tests. Prescriptions subsequent to nonindicated testing were provided to 20% of patients. Vitamin D-related imaging tests were conducted on 5% of patients during the 24 months following testing.
“In a subset of these patients who had nonindicated vitamin D tests, there seems to be high variability in care pathways and some opportunities to improve care quality. We also observed evidence of a low-value service cascade during the 24 months following a nonindicated vitamin D test,” concluded the study authors.
“Taken together, these results provide insight into primary care clinicians' practice patterns in light of evolving research and conflicting guidelines related to the clinical management of vitamin D status.”—Lisa Kuhns
