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Use of vitamin B₁₂ injections among elderly patients by primary care practitioners in Ontario

Dr. van Walraven is an Assistant Professor of Medicine at the University of Ottawa, Associate Investigator with the Loeb Health Research Institute, Ottawa, Ont., and Adjunct Scientist at the Institute for Clinical Evaluative Sciences, Toronto, Ont.; Dr. Naylor is a Professor of Medicine at the University of Toronto and Senior Scientist Emeritus at the Institute for Clinical Evaluative Sciences, Toronto, Ont.

Abstract

Background: Excess use of parenteral vitamin B₁₂ has been reported from audits of clinical practices. The authors assessed the use of vitamin B (₁₂) injections in patients aged 65 years and over in Ontario.

Methods: A cross-sectional analysis was conducted that included all elderly people covered by the Ontario Health Insurance Plan who received insured services from general practitioners or family physicians (GP/FPs). For each practice the proportion of elderly patients who received regular vitamin B₁₂ injections between July 1996 and June 1997 was calculated. The frequency of injections was determined for each patient receiving regular B₁₂ replacement.

Results: Of the 1 196 748 elderly patients (mean age 74.8 [standard deviation 6.8], 58.0% female) treated by 14 177 GP/FPs, 23 651 (2.0%) received regular B₁₂ injections. The rate of B₁₂ injections per patient, standardized for age and sex, varied between practices (range 0%-48.6%). Although no authoritative sources support the practice, 3303 (19.8%) of the 16 707 patients receiving long-term parenteral therapy had, on average, overly frequent injections (more than 1 injection every 4 weeks). For 76 (12.3%) of the 617 practices with 10 or more patients receiving regular vitamin B₁₂ injections, the mean injection frequency was greater than once every 4 weeks. The proportion of patients in these 617 practices who received overly frequent injections varied extensively (0%-100%).

Interpretation: Our findings indicate that some primary care physicians in Ontario administer unnecessary vitamin B₁₂ injections to elderly patients.

This article has been cited by other articles:

				C. C Butler, J. Vidal-Alaball, R. Cannings-John, A. McCaddon, K. Hood, A. Papaioannou, I. Mcdowell, and A. Goringe Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency: a systematic review of randomized controlled trials Fam. Pract., June 1, 2006; 23(3): 279 - 285. [Abstract] [Full Text] [PDF]

				F. Anello Vitamin B12 injections for the elderly Can. Med. Assoc. J., May 1, 2000; 162(9): 1274 - 1275. [Full Text] [PDF]

				C. G. van Walraven and C. D. Naylor Vitamin B12 injections for the elderly Can. Med. Assoc. J., May 1, 2000; 162(9): 1275 - 1276. [Full Text] [PDF]

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