‘Closing the loop’: re-audit of the diagnosis and management of vitamin B12 deficiency in general practice

INTRODUCTION: Vitamin B12 deficiency is common in Ireland, The Irish Longitudinal Study on Aging (TILDA) survey indicates 12% of over 50s in Ireland are low or deficient. The condition is commonly managed exclusively in general practice. AIM: The intention of this audit was to establish whether B12 deficiency is diagnosed correctly and whether there was over-treatment of patients. METHODS: The audit was conducted in an urban general practice in midwest Ireland. The primary limitation was the low number of patients. Thirty-five patients were included after practice database searches. An initial audit was performed which compared with the standard, Royal University of Bath: ‘Guidelines for the Investigation & Management of B12 deficiency’. RESULTS: The recommendations from this audit were to complete follow-on investigations and to switch over patients from IM to oral replacement. Twenty-one patients were then recalled, and investigations were performed. Ten patients were then switched from IM replacement to oral therapy. A re-audit was then completed. The re-audit showed marked improvement in compliance, from 17% (n = 6) to 83% (n = 29). The reduction in patients on IM therapy will decrease practice burden, with an annual reduction of nurse consultations by 46, representing a 30% decrease in nurse consultations for IM vitamin B12. This equates to an annual cost reduction of €1,340. CONCLUSION: This closed loop audit demonstrated that there was over treatment and under investigation of patients with B12 deficiency in general practice and that auditing of this process could both reduce risk for patients and save money and time.