Oral vitamin B₁₂therapy in the primary care setting: a qualitative and quantitative study of patient perspectives

Although oral replacement with high doses of vitamin B₁₂ is both effective and safe for the treatment of B₁₂ deficiency, little is known about patients' views concerning the acceptability and effectiveness of oral B₁₂. We investigated patient perspectives on switching from injection to oral B₁₂ therapy.

This study involved a quantitative arm using questionnaires and a qualitative arm using semi-structured interviews, both to assess patient views on injection and oral therapy. Patients were also offered a six-month trial of oral B₁₂ therapy. One hundred and thirty-three patients who receive regular B₁₂ injections were included from three family practice units (two hospital-based academic clinics and one community health centre clinic) in Toronto.

Seventy-three percent (63/86) of respondents were willing to try oral B₁₂. In a multivariate analysis, patient factors associated with a "willingness to switch" to oral B₁₂ included being able to get to the clinic in less than 30 minutes (OR 9.3, 95% CI 2.2–40.0), and believing that frequent visits to the health care provider (OR 5.4, 95% CI 1.1–26.6) or the increased costs to the health care system (OR 16.7, 95% CI 1.5–184.2) were disadvantages of injection B₁₂. Fifty-five patients attempted oral therapy and 52 patients returned the final questionnaire. Of those who tried oral therapy, 76% (39/51) were satisfied and 71% (39/55) wished to permanently switch. Factors associated with permanently switching to oral therapy included believing that the frequent visits to the health care provider (OR 35.4, 95% CI 2.9–432.7) and travel/parking costs (OR 8.7, 95% CI 1.2–65.3) were disadvantages of injection B₁₂. Interview participants consistently cited convenience as an advantage of oral therapy.

Switching patients from injection to oral B₁₂ is both feasible and acceptable to patients. Oral B₁₂ supplementation is well received largely due to increased convenience. Clinicians should offer oral B₁₂ therapy to their patients who are currently receiving injections, and newly diagnosed B₁₂-deficient patients who can tolerate and are compliant with oral medications should be offered oral supplementation.