Doctors not consistent on prescribing Vitamin D (Pakistan in this case)

Created July 2018

Knowledge Attitude and Practices about Management of Vitamin D Deficiency among Doctors in Pakistan

Pak J Med Res Vol. 57, No. 2, 2018

Madeeha Hassan , Muhammad Shais Khan , Muhammad Rehan , Tayyaba Tariq , Ali Jawa, S H Waqar

* 372 types of vitamin D prescriptions in France, 200,000 IU was the most popular – Oct 2013 * UK survey of vitamin D knowledge of midwives - 2011 * UK people and doctors still clueless about vitamin D – Survey Oct 2014 * Vitamin D survey of general practitioners in New Zealand – June 2013 * US OB-GYN Vitamin D survey – lack consensus, lots to learn – Aug 2016 * 21 reasons why doctors are reluctant to accept Vitamin D * Do not expect your doctor to know about vitamin D * Why doctors are so reluctant to try new things like vitamin D * 2000 IU of vitamin D- doctors trained that it was too much, but it is often too little * Doctors: If you pick one vitamin, make it D (99 cent ebook) – Jan 2016 * Do not expect a doctor to recommend a pill which will eliminate his job (vitamin D) * Doctors rarely (15 prcnt) talked about Vitamin D and with very little ambiguity (96 prcnt)– Aug 2016 Country Surveys * Doctors have a lot to learn about Vitamin D (Polish doctors in this case) – July 2021 * Doctors not consistent on prescribing Vitamin D (Pakistan in this case) July 2018 * UK people and doctors still clueless about vitamin D – Survey Oct 2014 * Dutch doctors still have a lot to learn about Vitamin D – survey Dec 2018 Controversies and Consensus * Minimum National Vitamin D recommendations range from 200 to 4,000 IU – July 2021 * Controversies and consensus in Vitamin D – 3rd Conference Sept 2019 * Vitamin D supplementation guidelines (adults – 50,000 IU per week) – Feb 2017 * Seniors need at least 4,000 IU vitamin D, no test needed – Consensus Jan 2014 1. 65 VitaminDWiki pages contained DOCTOR in title as of July 2021 Click here

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Dosing Variety

Background: Hypovitaminosis D is a common health issue in Pakistan because of its high prevalence. The awareness and practices of doctors treating vitamin D deficiency needs to be highlighted, as it will help in managing this public issue.

Objectives: To assess knowledge, attitude and practices for diagnosing and treating hypovitaminosis D among practicing doctors in Pakistan.

Subjects and Methods: Clinicians from different cities of the Pakistan were participated for a cross-sectional descriptive questionnaire based study about their approach in treating vitamin D deficiency. Results were analyzed using SPSS version 20. Descriptive statistics were calculated.

Results: One hundred eighty eight (188) practicing doctors from 21 different cities of Pakistan participated in the study. Majority (85.6%, n=161) prescribed vitamin D levels in patients of hypovitaminosis D. It is empirically treated by 101 (53.7%). Most clinicians (84%, n=158) prescribe Cholecalciferol, 19 (10.1%) Alfacalcidol and 11(5.9%) prescribe Calcitriol as a vitamin D supplement, while 155 (82.4%) prescribe a maintenance dose.

The prescription form preferred by doctors is tablets by 49 (26.1%), capsule by 29 (15.4%), oral injections by 68 (36.2%) and intra-muscular by 42 (22.3%). As a follow up tool, 84 (42.6%) clinicians order serum 25(OH) D and serum calcium levels, 102 (54.3%) assess patients by improvement in clinical symptoms and 3(1.9%) use both strategies for assessment. Nutritional advice was also given by most doctors.

Conclusion: There is no uniform approach for diagnosing and treating hypovitaminosis D among practicing doctors in Pakistan. A great variability and gap is seen in prescription options, dosing frequency and duration. This highlights the importance of need for a national guideline regarding prophylaxis, diagnosis and treatment of vitamin D deficiency.

Tags: Middle East