title: Iron deficiency intravenous substitution in a Swiss academic primary care division: analysis of practices.
abstract: BACKGROUND
  Iron deficiency is a common problem in primary care and is usually treated with oral iron substitution. With the recent simplification of intravenous (IV) iron administration (ferric carboxymaltose) and its approval in many countries for iron deficiency, physicians may be inclined to overutilize it as a first-line substitution.
  
  
  OBJECTIVE
  The aim of this study was to evaluate iron deficiency management and substitution practices in an academic primary care division 5 years after ferric carboxymaltose was approved for treatment of iron deficiency in Switzerland.
  
  
  METHODS
  All patients treated for iron deficiency during March and April 2012 at the Geneva University Division of Primary Care were identified. Their medical files were analyzed for information, including initial ferritin value, reasons for the investigation of iron levels, suspected etiology, type of treatment initiated, and clinical and biological follow-up. Findings were assessed using an algorithm for iron deficiency management based on a literature review.
  
  
  RESULTS
  Out of 1,671 patients, 93 were treated for iron deficiency. Median patients' age was 40 years and 92.5% (n=86) were female. The average ferritin value was 17.2 μg/L (standard deviation 13.3 μg/L). The reasons for the investigation of iron levels were documented in 82% and the suspected etiology for iron deficiency was reported in 67%. Seventy percent of the patients received oral treatment, 14% IV treatment, and 16% both. The reasons for IV treatment as first- and second-line treatment were reported in 57% and 95%, respectively. Clinical and biological follow-up was planned in less than two-thirds of the cases.
  
  
  CONCLUSIONS
  There was no clear overutilization of IV iron substitution. However, several steps of the iron deficiency management were not optimally documented, suggesting shortcuts in clinical reasoning.
authors.affiliation: Department of Community, Primary and Emergency Care, Division of Primary Care, Geneva University Hospitals, Geneva.
authors.forename: Monica
authors.initials: M
authors.lastname: Varcher
authors.affiliation: Department of Community, Primary and Emergency Care, Division of Primary Care, Geneva University Hospitals, Geneva.
authors.forename: Sofia
authors.initials: S
authors.lastname: Zisimopoulou
authors.affiliation: Department of Community, Primary and Emergency Care, Division of Primary Care, Geneva University Hospitals, Geneva.
authors.forename: Olivia
authors.initials: O
authors.lastname: Braillard
authors.affiliation: Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
authors.forename: Bernard
authors.initials: B
authors.lastname: Favrat
authors.affiliation: Department of Community, Primary and Emergency Care, Division of Primary Care, Geneva University Hospitals, Geneva.
authors.forename: Noëlle
authors.initials: N
authors.lastname: Junod Perron
keywords: cross-sectional design; general practice; iron deficiency; iron substitution; quality of care