Reducing vitamin testing in primary care practice

An every year increasing numbers of vitamin diagnostic tests are being ordered by general practitioners. Often there is no clear clinical reasoning or indication for these tests. Furthermore, this testing has been shown to result in over-diagnosing, over-treatment, medicalization, with very limited health benefits. The REVERT study aims to reduce unnecessary ordering of vitamin D and B12 diagnostic tests in primary care by educating general practitioners about merits and pitfalls of vitamin D and B12 testing and communication about this topic and these tests with their patients. Education will be based on existing, evidence-based current primary care guidelines. The additional value of informing patients will also be investigated.

The numbers of diagnostic vitamin D and B12 tests ordered in general practice will reduce by a de-implementation strategy, comprising:

- education of general practitioners using existing guidelines on vitamin D and B12 tests ordering

- techniques for general practitioners to communicate and discuss this topic with their patients

- feedback for practices on numbers of vitamin tests in the previous years

- educational materials for patients

Primary and secondary endpoints will be determined by comparing data from a complete year after the intervention to those from a complete year prior to the intervention.
After the intervention, about 10 general practitioners and about 10 patients will be interviewed.

The intervention, targeted at general practitioners, will be a meeting (Diagnostisch Toets Overleg) in which education on existing guidelines for vitamin D and B12 and communication with patients about this topic will be offered by an expert. General practitioners will also receive feedback on the history of vitamin D and B12 tests ordering of their practices.
In the other arm, general practitioners have the same educational meeting, and patients in their practices will be informed about this topic using written information material and via screens in the waiting room.