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Reducing unnecessary vitamin testing in general practice: barriers and facilitators according to general practitioners and patients
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  • Published on:
    Vitamin test: on patient or doctor's request?

    Thank you for this critical note about vitamin D and B12 testing. The aim of our study was to explore the barriers and facilitators for reducing the number of unnecessary ordered vitamin D and B12 laboratory tests. We found that GPs experienced difficulty to request laborotory tests only for evidenced based indications; often vitamin testing was performed to satisfy patients' requests. We acknowledge the presence of certain medical indications to test vitamin D or B12 bloodlevels and we also performed a training for participating GPs of our study on vitamin D and B12 deficiency and people at risk of such deficiency. The purpose of our study was not to reduce the number of vitamin D and B12 tests to zero, but to explore the barriers and facilitators related to vitamin D and B12 testing in order to improve properly indicated vitamin testing in general practice.

    Conflict of Interest:
    None declared.
  • Published on:
    Vitamin D and B12; why both under the same umbrella?
    • Maria Salinas, Laboratory Director Hospital Universitario de San Juan de Alicante

    The article of Hofstede et al on unnecessary vitamin testing in general practice deals with exploring the barriers and facilitators to reduce the number of (unnecessary) vitamin D and B12 laboratory testing.
    We consider that there are significant differences between both laboratory tests. It is true that neither vitamin D nor B12 tests are recommended for screening purposes, and their request from primary care has exponentially increased over time. Nonetheless, the latter is not equivalent to inappropriate demand.
    It is known that vitamin D over testing is common in certain scenarios; and it can result in over treatment and potential intoxication. The vitamin B12 case is, however, a completely different topic. Subjects with vitamin B12 deficiency do not often show anemia, macrocytosis nor specific symptoms of vitamin deficiency and the adverse effects of such a condition, especially neurological symptoms that could be irreversible if not treated in six months. That is the reason why the laboratory professional should be screening for new deficit cases; especially, when an easy and affordable treatment is available - a monthly intramuscular supplementation - without any possibility of intoxication.
    Less than half of patients with vitamin B12 deficiency have macrocytosis. However, macrocytosis can be used to improve the diagnosis of severe vitamin B12 deficiency through computer-assisted interventions in the clinical laboratory process. Additionally, morpho...

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    Conflict of Interest:
    None declared.