Patient Safety, Self-injection and B12 Deficiency: a UK Cross-sectional Survey

Background: Individuals with vitamin B12 deficiency and pernicious anaemia often report being ‘let down’ or stigmatised by general practice systems and policy and chose to instead self-medicate via injection, the association between this and perceptions of safe primary care in this group of people is unknown. Aim: To examine the association between self-medication and patient-reported safety in primary care. Design and Setting: A UK cross-sectional online survey. Methods: Survey consisted of the three components: a) demographics, b) the validated Primary Care Patient Measure of Safety, and c) questions about self-medication. Multivariable logistic regression analyses and thematic synthesis were undertaken. Results: Responses from 1,297 participants, indicated 508 (39%) self-medicated via injection. Perceived primary care safety was low. Those who self-medicated via injection reported a significantly lower level of patient safety in primary care including adverse patient-related factors (OR=0.82, 95%CI: 0.73 to 0.92), and patients over the age of 34 were significantly more likely to self-medicate via injection. Many reported treatment under the guidance of a clinician was preferable, but felt they had no other choice to regain quality of life. Almost half felt the doctor did not always consider what they wanted for their care. Conclusion: The largest study to date examining patient safety and vitamin B12 deficiency found that four out of 10 patients with B12 deficiency self-medicate via injection. Patients who self-medicated, perceived primary care as less safe. Providing patient-centred care and treating these patients with dignity and respect is a policy priority to reduce unsafe health behaviours.