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Shifts in B12 opinions in primary health care of Sweden

Department of Clinical Neuroscience, Occupational Therapy and Elderly Care Research, Division of Geriatric Medicine, Karolinska Institute/Huddinge Hospital, Stockholm

Mats Nilsson

Department of Community Health, County Council of Västerbotten, UmeÅ

Bo Norberg

Department of Internal Medicine, University Hospital of Northern Sweden, UmeÅ, Sweden, bo.norberg.us{at}vll.se

Johan Hultdin

Department of Medical Biosciences, Clinical Chemistry, University Hospital of Northern Sweden, UmeÅ, Sweden

Herbert Sandström

Family Medicine, University Hospital of Northern Sweden, UmeÅ, Sweden

Göran Westman

Family Medicine, University Hospital of Northern Sweden, UmeÅ, Sweden

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 B ₁₂-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.

Key Words: attitudes • cost • deficiency • epidemiology • management • vitamin B12.

Scandinavian Journal of Public Health, Vol. 29, No. 2, 122-128 (2001)
DOI: 10.1177/14034948010290020901


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