Shifts in B12 opinions in primary health care of Sweden

Abstract

Aims: The diagnosis and management of vitamin B₁₂ deficiency varies between countries and within countries. The aim of the study was to map current attitudes and values behind clinical decision-making in Swedish primary health care, which has a unique B₁₂ tradition: two patients out of three are treated with oral high-dose cyanocobalamin. Most patients with B₁₂-associated problems are managed in primary health care by general practitioners (GPs). Methods: The study was designed to elucidate possible opinion shifts among GPs during the period 1996- 1998. GPs (n=499), stratified and randomized, received a questionnaire with 24 statements on B₁₂-associated clinical and laboratory problems, to be evaluated by a visuo-analogue scale. Results: The majority of GPs in primary health care in Sweden accepted homocysteine and methylmalonic acid (MMA) as markers for functional deficiency of vitamin B₁₂. The evaluation of classical markers of B₁₂ deficiency was wary and balanced. There was a consensus of the need for B₁₂ therapy to risk groups such as patients with atrophic gastritis or previous gastric surgery. The answers also appeared to refl ect an improvement of professional knowledge and competence concerning B₁₂-associated problems among Swedish GPs between 1996 and 1998. Conclusions: The overriding conclusion was that B₁₂-associated opinions of Swedish GPs were stable within the period studied, with marginal improvements of knowledge and competence.

Keywords

attitudes cost deficiency epidemiology management vitamin B12.

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