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Australians paying for most Vitamin D tests, 40 percent deficient in winter - March 2019

Changes to the frequency and appropriateness of vitamin D testing after the introduction of new Medicare criteria for rebates in Australian general practice: evidence from 1.5 million patients in the NPS Medicine Insight database

BMJ Open http://dx.doi.org/10.1136/bmjopen-2018-024797
David Gonzalez-Chica1,2, Nigel Stocks1

VitaminDWiki

Australia now only pays for vitamin D tests where it is associated with a handfull of conditions
This restriction has reduced total cost of testing, but will probably end up increasing total cost of health problems due to undetected low vitamin D

Items in both categories Australia/NZ and Vitamin D Test are listed here:

Tests for Vitamin D contains the following overview/opinion

  • Fact: Many countries no longer pay for more than 1 or even any Vitamin D tests
      They feel that vitamin D testing is not needed except for a few conditions
  • Fact: Vitamin D tests are not very accurate/consistent: typically +- 5 nanograms
  • Opinion: Home blood spot tests have similar accuracy/repeatability as the lab tests
  • Fact: Low cost vitamin D tests are coming, but are not available in the US yet
       Low-cost test by Nanosys is available outside of the US
       both yes/no 35 ng and quantitative ($13 in quantity)
       update Low-cost Vitamin D testers (about 13 dollars in quantity) – Feb 2018 including cost of readout device
  • Fact: 3 major gene problems are not noticed by standard Vitamin D tests
       ~ 20% of Vit D tests show OK levels in blood when genes restrict VitD getting to cells
       Hint that Vit D not getting to cells: Vit D related diseases run in your family
  • Fact: A vitamin D test will rarely (<1 in 1000) indicate that you are getting too much
  • Opinion: If only getting a single test, wait till after supplementing with Vit D
       3 months after starting a maintenance dose or 4 weeks after a loading dose

 Download the PDF from VitaminDWiki

40% of Australians who had to pay for their own Vitamin D test
   (no medical reason/justification)   were found to have <20 ng of vitamin D in the winter

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Lots of Vitamin D deficiency far from the equator

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Note: Melborne latitude = 38 degrees = San Francisco

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Objectives To assess changes in the frequency of vitamin D testing and detection of moderate/severe vitamin D deficiency (<30 nmol/L) among adults after the introduction of new Medicare Benefits Schedule (MBS) rebate criteria (November 2014), and their relationship to sociodemographic and clinical characteristics.

Design Dynamic (open) cohort study

Setting Primary care

Participants About 1.5 million ‘active’ patients aged 18+ years visiting a general practitioner and included in the National Prescribing Service Medicine Insight database.

Outcome measures The frequency of vitamin D testing (per 1000 consultations) and moderate/severe vitamin D deficiency (%) recorded between October 2013 and March 2016, stratified by the release of the new MBS criteria for rebate.

Results More patients were female (57.7%) and 30.2% were aged 60+ years. Vitamin D testing decreased 47% (from 40.3 to 21.4 tests per 1000 consultations) after the new MBS criteria, while the proportion of tests with no indication for being performed increased from 71.3% to 76.5%. The proportion of patients identified as moderate/severe vitamin D deficient among those tested increased from 5.4% to 6.5%. Practices located in high socioeconomic areas continued to have the highest rates of testing, but moderate/severe vitamin D deficiency detection remained 90% more frequent in practices from low socioeconomic areas after the rebate change. Furthermore, the frequency of individuals being tested was reduced independent of the patients’ sociodemographic or clinical condition, and the gap in the prevalence of vitamin D deficiency detection between those meeting or not meeting the criteria for being tested remained the same. Moderate/severe vitamin D deficiency detection decreased slightly among patients with hyperparathyroidism or chronic renal failure.

Conclusions Although the new criteria for rebate almost halved the frequency of vitamin D testing, it also lessened the frequency of testing among those at higher risk of deficiency, with only a small improvement in vitamin D deficiency detection.

Conclusions (from PDF)

Although the new criteria for rebate almost halved the frequency of vitamin D testing, it also

  • lessened the frequency of testing among those at highest risk of deficiency,
  • increased the proportion of tests with no indication for being performed, and
  • resulted in only a small improvement in the detection of vitamin D deficiency.

Therefore, despite a marked reduction in healthcare (testing) costs,
the introduction of the new MBS criteria for rebate resulted in some unintended consequences: the changes

  • did not improve the appropriateness of vitamin D testing,
  • did not provide additional benefits for those at a higher risk of vitamin D deficiency and
  • did not reduce health disparities in Australian general practice.

Further studies could explore the ongoing, non-financial, health costs of these changes and develop practice, GP and patient-centric interventions to improve the appropriateness of vitamin D testing.

Created by admin. Last Modification: Saturday March 9, 2019 13:29:25 GMT-0000 by admin. (Version 9)

Attached files

ID Name Comment Uploaded Size Downloads
11539 VIC TAS table.jpg admin 09 Mar, 2019 12:54 78.02 Kb 17
11538 VIC TAS.jpg admin 09 Mar, 2019 12:54 21.52 Kb 11
11537 Less than 20 ng.jpg admin 09 Mar, 2019 12:53 73.25 Kb 12
11536 Aust test after stop paying.pdf PDF 2019 admin 09 Mar, 2019 12:53 1.36 Mb 6
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