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Original article
Primary care requests for anaemia chemistry tests in Spain: potential iron, transferrin and folate over-requesting
  1. Maria Salinas1,2,
  2. Maite López-Garrigós1,
  3. Emilio Flores1,3,
  4. Carlos Leiva-Salinas4
  5. on behalf of the Pilot Group of the Appropriate Utilization of Laboratory Tests (REDCONLAB) working group
    1. 1Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain
    2. 2Department of Biochemistry and Molecular Pathology, Universidad Miguel Hernández, Elche, Spain
    3. 3Department of Clinical Medicine, Universidad Miguel Hernández, Elche, Spain
    4. 4Department of Radiology, University of Virginia, Charlottesville, Virginia, USA
    1. Correspondence to Dr Maria Salinas, Clinical Laboratory, Hospital Universitario de San Juan, Carretera Alicante-Valencia, s/n, San Juan de Alicante 03550, Alicante, Spain; salinas_mar{at}gva.es

    Abstract

    Aim To study the regional variability of requests for anaemia chemistry tests in primary care in Spain and the associated economic costs of potential over-requesting.

    Methods Requests for anaemia tests were examined in a cross-sectional study. Clinical laboratories from different autonomous communities (AACCs) were invited to report on primary care anaemia chemistry tests requested during 2014. Demand for iron, ferritin, vitamin B12 and folate tests per 1000 inhabitants and the ratios of the folate/vitamin B12 and transferrin/ferritin requests were compared between AACCs. We also calculated reagent costs and the number of iron, transferrin and folate tests and the economic saving if every AACC had obtained the results achieved by the AACC with best practice.

    Results 110 laboratories participated (59.8% of the Spanish population). More than 12 million tests were requested, resulting in reagent costs exceeding €16.5 million. The serum iron test was the most often requested, and the ferritin test was the most costly (over €7 million). Close to €4.5 million could potentially have been saved if iron, transferrin and folate had been appropriately requested (€6 million when extrapolated to the whole Spanish population).

    Conclusions The demand for and expenditure on anaemia chemistry tests in primary care in Spain is high, with significant regional differences between different AACCs.

    • PERNICIOUS ANAEMIA
    • LABORATORY TESTS
    • B12
    • IRON METABOLISM

    https://doi.org/10.1136/jclinpath-2016-204249

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      Footnotes

      • Handling editor Mary Frances McMullin

      • Collaborators Members of the REDCONLAB working group are as follows: Vidal Perez Valero (Hospital Regional Universitario de Malaga, Hospital Universitario Virgen de la Victoria); Félix Gascón (Hospital Valle de los Pedroches, Pozoblanco); Isidoro Herrera Contreras (Complejo Hospitalario de Jaen); Maria Angeles Bailen Garcia (Hospital Universitario Puerta del Mar de Cadiz); Cristobal Avivar Oyonarte (Hospital de Poniente, El Ejido); Esther Roldán Fontana (A.G.S. de Osuna); Fernando Rodriguez Cantalejo (Hospital Universitario Reina Sofia de Cordoba); Jose Angel Noval Padillo (Hospital Universitario Virgen del Rocio); M Angela Gonzalez García (AGS Norte de Cadiz); Ignacio Vazquez Rico (Hospital Juan Ramon Jimenez de Huelva); Cristina Santos (Hospital Rio Tinto); Angeles Giménez Marín (Hospital de Antequera); Maria del Señor López Vélez (Hospital San Cecilio de Granada, Hospital Virgen de las Nieves, Granada); Federico Navajas Luque (AGS Este de Málaga-Axarquía); Amado Tapia (Hospital de Barbastro); Maria Esther Sole Llop (Hospital de Alcañiz); Juan Jose Puente (Hospital Clínico Universitario Lozano Blesa); Patricia Esteve (Hospital Ernest Lluch); Maria Teresa Avello Lopez (Hospital San Agustín-Aviles, Hospital Valle del Nalon); Emilia Moreno Noguero (Hospital Can Misses); Ana Maria Follana Vazquez (Hospital Mateu Orfila); Jose Luis Ribes Valles (Hospital de Manacor); Mª Luisa Fernández de Lis Alonso (Area de Salud de Fuerteventura); MC Martin-Fernández de Basoa (Hospital Nuestra Señora de la Candelaria, Tenerife); Leopoldo Martin Martin (Hospital General de la Palma); Miguel Angel Pico Picos (Hospital Universitario de Canarias); Casimira Dominguez Cabrera (Hospital Universitario de Gran Canaria Dr Negrín); Marta Riaño Ruiz (Hospital Insular de Gran Canaria); Juan Ignacio Molinos (Hospital Sierrallana de Torrelavega); Luis Fernando Colomo (Hospital de Laredo); José Carlos Garrido (Hospital Universitario Marques de Valdecilla); Enrique Prada de Medio (Hospital Virgen de la Luz de Cuenca); Pilar Garcia Chico (Hospital General Universitario de Ciudad Real); Simon Gomez-Biedma (Hospital General de Almansa); Jesús Domínguez (Hospital Universitario de Guadalajara); Guadalupe Ruiz (Complejo Hospitalario de Toledo); Laura Navarro Casado (Complejo Hospitalario Universitario de Albacete); Fidel Velasco Pena (Hospital Virgen de Altagracia, Manzanares); Carolina Andrés Fernandez (Hospital General de Villarobledo); Oscar Herraez Carrera (Hospital C.H. La Mancha Centro_Alcazar de San Juan); Mª Carmen Lorenzo Lozano (Hospital Santa Bárbara de Puertollano); Joaquín Domínguez Martinez y Oscar Herrera Carrera (Hospital General Mancha Centro y Hospital General de Tomelloso); Maria Teresa Gil (Hospital Nuestra Señora del Prado Talavera de la Reina); Mª Angeles Rodriguez Rodriguez (Complejo Asistencial Universitario de Palencia (Hospital Rio Carrion)); M. Victoria Poncela Garcia (Hospital Universitario de Burgos); Luis Rabadan (Complejo Asistencial de Soria); Vicente Villamandos (Hospital Santos Reyes, Aranda del Duero); Nuria Fernandez Garcia (Hospital Universitario Rio Hortega-Valladolid); Jose Miguel Gonzalez Redondo (Hospital Santiago Apostol de Miranda de Ebro); Cesareo Garcia (Hospital Universitario de Salamanca); Luis Garcia Menendez (Hospital El Bierzo); Pilar Alvarez Sastre (Complejo Asistencial de Zamora); Maria Dolores Calvo Nieves (Hospital Cínico Universitario de Valladolid); Mabel LLovet (Hospital Universitario Verge de la Cinta (Tortosa)); Nuria Serrat (Hospital Joan XXIII de Tarragona); Mª José Baz (Hospital de Llerena, Badajoz); Maria Jose Zaro (Hospital Don Benito-Villanueva); M Carmen Plata (Hospital Campo Arañuelo, Navalmoral de la Mata); Pura Garcia Yun (Área de Salud de Badajoz (Hospital Infanta Cristina, Hospital Perpetuo Socorro y Hospital Materno Infantil)); Milagrosa Macías Sánchez (Area de Salud de Caceres (Complejo Hospitalario San Pedro de Alcantara)); Javier Martin (Hospital Virgen del Puerto de Plasencia); Lola Máiz Suarez (Hospital Lucus Augusti, Lugo); Berta Gonzalez Ponce (Hospital Da Costa, Burela); Aida Pérez Fuertes (Hospital Arquitecto Marcide, El Ferrol); M. Amalia Andrade Olivie (Hospital Xeral-Cies, CHU Vigo); Pastora Rodriguez (Hospital Universitario de A Coruña); M. Mercedes Herranz Puebla (Hospital General Universitario Gregorio Marañon); Antonio Buño Soto (Hospital Universitario La Paz, Madrid); Fernando Cava y Raquel Guillén Santos (BR Salud); Tomas Pascual (Hospital Universitario de Getafe); Carmen Hernando de Larramendi (Hospital Severo Ochoa de Leganes); Raquel Blázquez Sánchez (Hospital de Mostoles); Pilar Díaz (Hospital 12 de Octubre, Madrid); Ana Díaz (Hospital Universitario de La Princesa); Marta Garcia Collia (Hospital Ramon y Cajal, Madrid); Maria Angeles Cuadrado Cenzual (Hospital Clinico Universitario San Carlos); Santiago Prieto (Hospital Universitario de Fuenlabrada); María del Carmen Gallego Ramírez (Hospital Rafael Mendez, Lorca); Jose Luis Quilez Fernandez (Hospital Universitario Reina Sofia de Murcia); Maria Dolores Albaladejo (Hospital Santa Lucia, Cartagena); Maria Luisa Lopez Yepes (Hospital Virgen del Castillo de Yecla); Alfonso Pérez Martínez (Hospital Morales Meseguer); Antonio López Urrutia (Hospital de Cruces, Bilbao); Adolfo Garrido Chércoles (Hospital Universitario de Donostia); Carmen Mar Medina (Hospital Galdakao-Usonsolo); M Carmen Zugaza (Unidad de Gestion Clinica de Alava); Francisco Javier Aguayo Gredilla (Hospital Universitario de Basurto); Silvia Pesudo Menchero (Hospital La Plana); Carmen Vinuesa (Hospital de Vinaros); Julian Díaz (Hospital Francesc de Borja, Gandia); Marisa Graells (Hospital General Universitario de Alicante); Diego Benitez Benitez (Hospital de Orihuela); Arturo Carratala (Hospital Clinico Universitario de Valencia); Consuelo Tormo (Hospital General de Elche); Francisco Miralles (Hospital Lluis Alcanyis, Xativa); Amparo Miralles (Hospital de Sagunto); Jose Luis Barberà (Hospital de Manises); Juan Molina (Hospital Comarcal de La Marina, Villajoyosa); Martin Yago (Hospital de Requena); Mario Ortuño (Hospital Universitario de la Ribera (Alzira)); Maria Jose Martinez Llopis (Hospital de Denia); Nuria Estañ (Hospital Dr. Peset); Ricardo Molina (Hospital Virgen de los Lirios, Alcoy); Juan Antonio Ferrero (Hospital General de Castellon); Begoña Laiz Marro (Hospital Universitario y Politecnico La Fe de Valencia); Goitzane Marcaida (Consorcio Hospital General Universitario de Valencia).

      • Contributors MS, ML-G, EF and CL-S conceived, designed and drafted the manuscript, and revised the final manuscript. All authors contributed to the concept, reviewed all versions of the manuscript and commented, and approved the final revised version of the manuscript.

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.