VARIABILITY IN ONTARIO LONG-TERM CARE PRACTICES FOR SCREENING AND TREATMENT OF VITAMIN B12 DEFICIENCY
K.J. Pfisterer, M.T. Sharratt, G.G. Heckman, H.H. Keller
Jour Nursing Home Res 2016;2:64-70
Background: Vitamin B12 deficiency is avoidable through screening and treatment. Deficiency in long-term care impacts ~35% of residents, yet it remains unclear as to what long-term care homes are doing to address this issue. Objective: For the first time, to describe the state of B12 screening and treatment protocols in Ontario long-term care homes, influence of geography and corporate structure on protocols, and the proportion of residents who are currently under treatment. Design: This cross-sectional study used stratified random sampling. Setting: Ontario long-term care homes. Participants: Forty-five standardized phone interviews were completed with the directors of nursing care. Measurements: The following measurements were collected: home demographics (geography, for-profit status etc.), protocols pertaining to vitamin B12 testing, treatment, the cut-point each home uses to define B12 deficiency, proportion of residents receiving B12 and the treatment method (intramuscular injection vs. oral). Results: Cut-off values for determination of B12 deficiency varied (31% <156 pmol/L). Admission and follow-up B12 testing were routinely conducted in 66% (30/45) and 88% (35/40) of long-term care homes respectively. On average 25 ± 16% of current residents received treatment (41/45 homes reporting). Conclusions: Variability in detection and treatment of B12 deficiency in LTC, potentially places residents at risk for undetected deficiency. Regular testing and monitoring beginning at admission may provide a solution, however, there is a need both for further studies targeted at addressing the effect of treatment on improved clinical outcomes as well as a formal cost-benefit analysis for screening and subsequent treatment.
K.J. Pfisterer ; M.T. Sharratt ; G.G. Heckman ; H.H. Keller ; (2016): Variability in Ontario long-term care practices for screening and treatment of vitamin B12 deficiency. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2016.9