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Unnecessary cyanocobalamin injections lead to increased healthcare burden by increasing office visits, injection associated complications and increased cost of care.High dose oral supplementation of cobalamin such as microgram or more daily instead of cyanocobalamin injections has been proven to be effective, safe, cost efficient and without pain or complications.A sublingual dose of g of cobalamin given either sublingually or orally is effective in correcting cobalamin deficiency as well.We implemented a plan to educate our primary care providers as well as our patients on appropriate available B treatment options.Treatment options included high dose oral or sublingual versus parenteral B injection.After providers completed an educational training session, they were encouraged to reassess their patients and discuss treatment options, the decision on appropriate route and dose of treatment of B deficiency was left to the treating physician and patients preference.Additional services offered onsite are: pharmacy, laboratory, radiology, <a href="http://www.targetmol.com/compound/Reboxetine">buy Reboxetine</a> ultrasonography, warfarin anticoagulation clinic, diabetic educator, and chronic disease management programs.A monthly average baseline of B injections was being dispensed which equated to more than injections per year.Physicians were educated on high dose oral and sublingual cobalamin supplementation in appropriate patients based on current available practice guidelines.Providers were given patient education materials to share with patients to aid in informing them of their treatment options.Patients were asked to make an appointment with their providers to review and reevaluate their cobalamin deficiency treatment plan and choose an appropriate treatment option.Physicians and patients discussed the specific clinical attributes of their B deficiency to determine an appropriate course of action whether to switch to high dose oralsublingual cobalamin or continue the parenteral cyanocobalamin injection.Patients were empowered to make an educated decision in regards to their treatment and the provider honored their decision.Patients were also provided regular opportunities to reevaluate their decision and were free to switch from oral to injection or injection to oral at any time.Regular primary care provider updates were provided during twice a month office staff meeting debriefs over   the course of months follow up.This translated to more than B injections at our office.We were a able to provideeboth providers a and patientswwith the currenttliterature, ger riatrics guidelin nes and remov ve the knowled dge and comfo ort gap thus reduci ing the rate of unnecessary cy yanocobalaminninjection bymmore than ppercent in mo onths.Vitamin B deficiencyiis common inggeriatric patien nts.Studies hav ve estimated itsprevalence toobe as high as. Many fact tors contributeeto this high prevalence, in ncluding someethat may co ontribute to a deficiency ov ver an extendedpperiod of time. Vitamin B, or cobalam min, is not synt thesized by th he body and th hus adequateddietary intake is essential.The useeof certain med dications may also precipitateecobalamin de eficiency.One cau use of malabsorpt tion may be at trophic gastriti s, a condition of chronic infl lammation oftthe mucous me embrane layer of the dults.The parie etal cells abilit ty to secrete in ntrinsic factor, another comp ponent necessaryffor proper vita amin B absor rption, is alsoiimpaired by at trophic gastriti s.Similar mala absorption issu ues are noted with achlorhydria and pernicious anemia due to insufficient secretion of hydrochloric acid and intrinsic factor, respectively.

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