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.