Background. Changes were made to the Australian guidelines for vitamin D testing in November 2014 which restricted the patients who could be tested and reimbursed under the Medical Benefits Schedule. A retrospective study was conducted to assess the impact of the changes.

Methods. Data from 588,021 cases tested for vitamin D over the period of 2014 to 2017 were obtained and the results in 149,808 cases tested before the change in guidelines were compared to 438,213 cases tested afterwards.

Results. The results showed an initial fall in requests took place after the introduction of changes, but request numbers had returned to pre-change levels by November 2016. Furthermore, following the intervention there was a significant reduction in the number of cases of vitamin D deficiency (<50 nmol/L) detected after November 2014 (p<0.001) with odds ratio (OR) calculations showing the strongest effect for the sub-cohort of 0-20 nmol/L (OR = 1.77). For patient vitamin D levels >71 nmol/L the pattern of detection inverted with more cases of sufficiency being detected after the intervention than before (OR from 0.84 – 0.48, p <0.001).

Conclusions. The failure to show a sustained reduction in vitamin D testing is a common finding with demand management strategies to limit test requesting. More significant is the failure of the intervention to improve the detection of vitamin D deficiency. These failures highlight the need for better tools to manage test requesting including the use of audit and outcomes measurement to guide future interventions.

背景。2014年11月，澳大利亚对维生素D的检测指南进行了更改，限制了可以根据医疗福利计划进行检测和报销的患者。进行了回顾性研究，以评估更改的影响。

方法。收集了2014年至2017年间588,021例接受维生素D检测的数据，将指南变更前的149,808例检测结果与之后的438,213例进行了比较。

结果。结果表明，引入变更后，申请量最初有所下降，但到2016年11月，申请量已恢复到变更前水平。此外，干预后，维生素D缺乏症的病例数大大减少了（在2014年11月之后检测到<50 nmol / L（p <0.001）（p <0.001），且优势比（OR）计算显示了0-20 nmol / L的亚人群的最强影响（OR = 1.77）。对于患者的维生素D水平> 71 nmol / L，在干预后比以前更能检测到充足病例的情况下，检测模式发生了倒置（或从0.84≤0.48，p <0.001）。

结论。未能显示维生素D测试持续减少的现象是需求管理策略限制测试要求的常见发现。更重要的是，干预措施未能改善对维生素D缺乏症的检测。这些失败突出表明需要更好的工具来管理测试请求，包括使用审计和结果度量来指导未来的干预措施。