title: Test ordering in an evidence free zone: Rates and associations of Australian general practice trainees' vitamin D test ordering.
abstract: OBJECTIVE
  Indiscriminate health screening is increasingly seen as being problematic. In particular, vitamin D testing rates are increasing rapidly despite recommendations against population screening. The purpose of this study was to determine the level of vitamin D testing among family practice/general practitioner (GP) trainees and to establish associations of this testing.
  
  
  METHODS
  Cross-sectional analysis of data from the ReCEnT (Registrars Clinical Encounters in Training) cohort study. The setting was GP practices in four Australian states. Data from 60 consecutive consultations per trainee were recorded each 6-month training term (up to four terms).
  
  
  RESULTS
  Vitamin D tests were ordered in 726 (1.0%) of encounters (n = 69 412). Vitamin D test ordering was significantly associated with patients being older, female and non-English speaking. Trainees were more likely to test if they worked in a completely bulk-billing practice (i.e. a practice without any patient payment), if more problems were dealt with, more pathology tests were ordered in the consultation and if a lipid profile was ordered. They were less likely to test if they sought in-consultation advice or information. The most common reasons for testing were 'check-up' and 'health maintenance'.
  
  
  CONCLUSIONS
  In this first report of associations of vitamin D testing in the GP setting, we found that non-targeted vitamin D testing (testing inconsistent with current guidelines) is widespread in GP trainees' practice. Adoption of more rational testing approaches is needed.
authors.affiliation: General Practice Training Valley to Coast, Mayfield, NSW, Australia.
authors.forename: Amanda
authors.initials: A
authors.lastname: Tapley
authors.affiliation: General Practice Training Valley to Coast, Mayfield, NSW, Australia.|Discipline of General Practice, University of Newcastle, Callaghan, NSW, Australia.
authors.forename: Parker
authors.initials: P
authors.lastname: Magin
authors.affiliation: General Practice Training Valley to Coast, Mayfield, NSW, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Morgan
authors.affiliation: General Practice Training Valley to Coast, Mayfield, NSW, Australia.
authors.forename: Kim
authors.initials: K
authors.lastname: Henderson
authors.affiliation: General Practice Training Valley to Coast, Mayfield, NSW, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Scott
authors.affiliation: Discipline of General Practice, University of Newcastle, Callaghan, NSW, Australia.
authors.forename: Allison
authors.initials: A
authors.lastname: Thomson
authors.affiliation: Victorian Metropolitan Alliance General Practice Training, Hawthorn, Vic., Australia.|Department of General Practice, University of Melbourne, Carlton, Vic., Australia.
authors.forename: Neil
authors.initials: N
authors.lastname: Spike
authors.affiliation: Adelaide to Outback General Practice Training, North Adelaide, SA, Australia.
authors.forename: Lawrie
authors.initials: L
authors.lastname: McArthur
authors.affiliation: Discipline of General Practice, School of Medicine, University of Brisbane, Brisbane, QLD, Australia.
authors.forename: Mieke
authors.initials: M
authors.lastname: van Driel
authors.affiliation: John Hunter Hospital Campus, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.
authors.forename: Patrick
authors.initials: P
authors.lastname: McElduff
authors.affiliation: McAuley Centre, Calvary Mater, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.
authors.forename: Billie
authors.initials: B
authors.lastname: Bonevski
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001315:Australia; D001774:Blood Chemical Analysis / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005194:Family Practice / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D058006:General Practice / Q000592:standards / Q000706:statistics & numerical data*; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012737:Sex Factors; D014807:Vitamin D / Q000097:blood*; D055815:Young Adult
chemical_list: D014807:Vitamin D
keywords: Education; Family Practice; General Practice; Testing; Trainees; Vitamin D; evidence-based medicine