Regarding the vitD question on the mail base, see some INFORMAL feedback from some Australian GPs below when being advised by our National Prescribing Service educational outreach facilitators about indications for vitD testing:
Kind regards, Rita
Prof. Andrea Rita Horvath, MD, PhD, EurClinChem, FRCPath, FRCPA
Past President of the European Federation of Clinical Chemistry and Laboratory Medicine
Clinical Director, SEALS North, Department of Clinical Chemistry
Level 4, Campus Centre, Prince of Wales Hospital
Barker Street, Randwick, NSW 2031, Sydney, Australia
Tel: (+612)-9382 9078
Fax: (+612)-9382 9099
Mobile No: (+61)-404 027 843
-----Original Message-----
From: Joanne Fisher [mailto:[log in to unmask]]
Sent: Wednesday, 9 October 2013 10:29 AM
To: Rita Horvath; Robyn Lindner; Aine Heaney
Subject: RE: Measurement fo Vitamin D concentration
Thank you Rita.
Our NPS facilitators have been involved in some fairly lengthy discussions with GPs regarding Vit D, esp with GPs who don't feel comfortable just advising supplementation in their pt until they confirmed that they were indeed Vit D deficient.
See some points below from their discussions with GPs
* GP wasn't comfortable with telling pt to supplement themselves without knowing how deficient they were, or if they were deficient in the first place, therefore you need to test. Also didn't feel comfortable with telling pt to get 'safe' sun exposure. Some of these GPs had themselves tested and they came back as <50nmol/L. Also thought supplements were too expensive to recommend if the pt wasn't deficient in the first place.
* It's a circular argument - sun exposure vs testing vs supplementing?
Some of our responses to this.
* One way to respond is to say "Firstly are these pt at risk of being very deficient'? If they are, it MAY be reasonable to test as an appropriate case finding strategy in high risk pt, but with many high risk pt, you could also advise supplementation without testing.
* Reiterate again that the results may be variable at the lower, clinically and analytically important range (< 50 nmol/L) of the assay. Will the test help guide your supplementation strategy?
* Can provide the guidance about supplementation from the MJA paper - https://www.mja.com.au/journal/2012/196/11/vitamin-d-and-health-adults-australia-and-new-zealand-position-statement
* If the pt is healthy and asymptomatic - what is the clinical reason for testing these pt, it is going to change your management, or is it a distraction?
* Indeed testing of healthy individuals may reveal a large population of healthy individuals with low 25OHD levels (but we are not sure how clinically significant that is for these pt). This could lead to treatment and repeat testing without knowledge whether these patients will actually benefit from vitamin D supplementation.
* If the GP doesn't feel comfortable with advising supplements prior to testing, could they test after supplementation (i.e. in 3 months time)?
* Some generic brand supplements are around $12. Obviously this is a direct cost to the pt, and the pathology test isn't seen as a direct cost.
Kind Regards
Jo
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