Shifts in B-12 opinions in primary health care of Sweden

Aims: The diagnosis and management of vitamin Bit deficiency varies between countries and within countries. The aim of the study was to map current at titudes and values behind clinical decision-making in Swedish primary healt h care. which has a unique B-12 tradition: two patients out of three are tr eated with Oral high-dose cyanocobalamin. Most patients with B-12-associate d problems are managed in primary health care by general practitioners (GPs ). Methods: The study was designed to elucidate possible opinion shifts amo ng GPs during the period 1996-1998. GPs (n = 499), stratified and randomize d, received a questionnaire with 24 statements on B-12-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 homocystein e and methylmalonic acid (MMA) as markers for functional deficiency of vita min B12 The evaluation of classical markers of B12 deficiency was wary and balanced. There was a consensus of the need for B-12 therapy to risk groups such as patients with atrophic gastritis or previous gastric surgery. The answers also appeared to reflect an improvement of professional knowledge a nd competence concerning B-12-associated problems among Swedish GPs between 1996 and 1998. Conclusions: The overriding conclusion was that B-12-associ ated opinions of Swedish GPs were stable within the period studied, with ma rginal improvements of knowledge and competence.