Implementation of an educational province-wide intervention to reduce redundant vitamin B-12 testing: A cross-sectional study

Introduction: We describe the implementation of an Alberta-wide intervention aimed at educating clinicians about redundant vitamin B-12 testing. We hypothesized that the introduction of an educational comment outlining recommended vitamin B-12 test intervals would reduce the annual number of vitamin B-12 tests performed. Materials and methods: We performed a cross-sectional observational study that included all vitamin B-12 tests ordered in Alberta between May 1, 2017 and April 30, 2018. An educational comment was appended to all vitamin B-12 test results in Alberta beginning May 2, 2017. Using a simple seasonal model, we compared predicted versus observed vitamin B-12 test volumes for the 12-month period following the introduction of the educational comment. The sole outcome measured was the monthly change in volume of vitamin B-12 testing. A cost-analysis of the effects of the intervention on test volumes was also performed. Results: Over the sum of the first 12 months of the intervention, 18,000 more vitamin B-12 tests were ordered compared to the predicted value in Alberta. With an estimated cost of $7 per test, this resulted in a $126,000 increase in costs for vitamin B-12 testing provincially. Conclusions: An educational intervention aimed at limiting inappropriate vitamin B-12 testing in Alberta did not alter testing as desired. Multiple utilization management strategies and a longer observation period may be needed to reduce redundant vitamin B-12 testing.