Pharmaceutical intervention for Vitamin D level

Eur J Hosp Pharm 2012;19:258 doi:10.1136/ejhpharm-2012-000074.454
P. Pascual Gonzalez, A. Asensio, P. Carmona, J. Barral, G. Lizeaga, I. Fernandez, E. Esnaola, B. Irastorza, O. Valbuena, M.P. Bachiller
Hospital Donostia, Pharmacy Service, San Sebastián, Spain

Background Vitamin D is essential for strong bones because it helps the body use calcium from the diet.
Because most people have low levels of vitamin D, correcting to the recommended ranges will bring added value to patient healthcare in hospital.

Purpose To detect patients with low vitamin D levels in an Orthopedic ward.
To evaluate the degree of acceptance of the pharmacist's recommendations to correct vitamin D levels by the physicians.
To devise an educational session for patients and evaluate the efficacy of the intervention.

Materials and methods From 7/03/2011 to 9/03/2011, total serum 25-hydroxycholecalciferol ((25OH)D3) was measured in patients on the Orthopedic ward.
A lack of vitamin D was defined as ((25OH)D3) ?30 ng/mL.
The individual recommendation for vitamin D supplementation was written in each patient's medical record by the pharmacist.

Patients presenting low vitamin D levels were randomised to enroll in the educational programme, consisting of a 15-min session about vitamin D, nutritional habits, and supplementation with vitamin D. All patients were given an appointment 2 months later for a vitamin D test to evaluate the efficacy of the intervention.

Conclusions There was a significant vitamin D deficiency in the population studied.
Pharmaceutical intervention has been proved useful when adjusting vitamin D levels.
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Abstract fails to say how much the education improved compliance

Education can be of several types – which include

• 1 on many = classroom
• 1-on-1 with a professional (very high cost)
• 1-on-1 with a volunteer (very low cost)
• Printed material
• Audio material - telephone access
• Video presentation
• FAQ on vitamin D
• Forum for asking questions, seeing what others have asked

See also VitaminDWiki

• After learning they were vitamin D deficient, only 8 percent normalized – April 2012
• Complex relationship between UVB and vitamin D – April 2012
  This article may result in a re-write of this web page. It questions many of the assumptions made here about
  Amount of skin area, color or skin, obesity, etc. There are several reasons why the study may be wrong however.
• All items in Noontime Sun 119 items as of May 2012
• An overview analysis of the time people spend outdoors – Dec 2010
• Melanoma risk with sunburns - 2010.PDF
• Poor knowledge by office workers of vitamin D and sunscreen - July 2010
• Scared Out of the Sun for Fifty Years – Jan 2011
• Overview Suntans and melanoma
• For small amounts of sunshine the amount of skin exposed may not matter – Jan 2011
• Minutes in the Sun for 1000 IU default 30 degrees North
  • Face 3.5%, neck 2%, trunk 26%, hands 6%, arms 14%, legs 14%, thighs 18%
• Many reasons why vitamin D deficiency has become epidemic in past 30-40 years
• Tanning while getting little vitamin D
• Whites were 2X more likely to be vitamin D deficient if wear long sleeves – Jan 2012
  No decrease, however, for reported use of sunscreen
• UK survey of vitamin D knowledge of midwives - 2011
• Survey of patient and doctor vitamin D knowledge - Nov 2010
• 28 pct of dark skinned people in UK not heard of vitamin D and 54 pct not know symptoms – Jan 2012
• UK pediatricians have a lot to learn about vitamin D – May 2012