Factors correlating to the propensity of general practitioners to substitute borderline vitamin B12 deficiency

Abstract

Objective: This study aims to identify factors which correlate to the propensity of general practitioners (GPs) to prescribe supplementation for borderline vitamin B12 deficiency.

Design: Cross-sectional surveys were distributed in person.

Setting: Conferences held in Cairns, Palm Cove Beach, Mt Isa; educational meetings in Atherton; and meetings with individual general practices within the Cairns and Hinterland region. All located in Queensland, Australia.

Subjects: 128 practicing GP specialists and registrars (practitioners in training).

Main outcome measures: Responses to the Likert scale statements with its five options scaling from ‘strongly disagree’ to ‘strongly agree’ were recoded to have binary outcomes for analysis.

Results: A survey response rate of 89% was achieved. Participants who felt patient demands influence the management of borderline vitamin B12 deficiency were more likely to prescribe supplementation (OR 2.4, p = 0.037). Participants who perceived an overuse of vitamin B12 were less likely to prescribe B12 (OR 0.39, p = 0.019). Participants who often saw patients with vitamin B12 deficiency were less likely to request for the complementary biomarkers plasma methylmalonic acid or total homocysteine (OR 0.41, p = 0.045).

Conclusions: The identified disparity to prescribe vitamin B12 for borderline deficiency may be described as an attempt in the GP collective to seek a balance between being the patient’s or the society’s doctor. We propose that relevant authorities try to reduce this disparity by describing a management strategy for borderline vitamin B12 deficiency.

Key points

• General practitioners hold different thresholds for commencing supplementation in cases of borderline vitamin B12 deficiency.

• Participants from Australia were asked to fill out a cross-sectional survey to explore factors which correlate with the propensity to prescribe in clinical practice.

• Our study identified that patient demands and a practitioner’s perception of whether there is an overuse of vitamin B12 in the community influenced the propensity to treat for deficiency.

• The results give insight into reasons for initiating supplementation, and will help inform general practitioners on their current management.

Keywords:

• Vitamin B12 deficiency
• dietary supplements
• general practice
• primary health care

Acknowledgements

The authors wish to thank the general practitioners who volunteered their valuable time to take part in the study.

Ethics approval and consent to participate

As per manuscript: approved by the Human Research Ethics Committee at James Cook University under the ethics approval number H6476.

Availability of data and materials

The authors declare that the data supporting the findings of this study are available within the article. Data for the statement regarding when last formal education was received are available from the corresponding author on reasonable request.

Disclosure statement

The authors declare that they have no competing interests.

Additional information

Funding

The project was financially supported in administrative (printing, stationery) and transport (fuel) costs by internal funding from James Cook University.

Notes on contributors

Grace Cham

Grace Cham is a resident at the Royal Brisbane and Women’s Hospital, Australia. At the time of writing she was a final year medical student at James Cook University, Australia. She is interested in General Practice and Obstetrics and Gynaecology.

Nichola Davis

Dr. Nichola Davis is a General Practitioner with over 25 years of experience. She has held the position of Senior Lecturer within the College of Medicine & Dentistry at James Cook University, Australia.

Edward Strivens

Dr. Edward Strivens is the Regional Geriatrician and Clinical Director for Older Persons and Subacute Services within the Cairns and Hinterland Hospital and Health Service, Australia. He is an Adjunct Associate Professor with James Cook University, and also the Co-Chair of Queensland Health’s Statewide Dementia Clinical Network.

Aileen Traves

Dr Aileen Traves is a General Practitioner and Senior Lecturer within the College of Medicine & Dentistry at James Cook University, Australia. She is passionate about improving the health of Aboriginal and Torres Strait Islander people.

Grant Manypeney

Dr Grant Manypeney is a General Practitioner practicing at Mareeba Medical Clinic, Australia. He is a dedicated supervisor and mentor to General Practice Registrars and supports local rural health initiatives.

Ronny Gunnarsson

Associate Professor Ronny Gunnarsson is a research supervisor to academic registrars, General Practitioners and PhD students in Primary Health Care for Narhalsan VGR and Gothenburg University, Sweden. He has previously worked as a general practitioner for 20 years, and served as Associate Professor in General Practice and Rural Medicine at James Cook University, Australia.