Patterns and Obstacles of Provision of Minor Orthopedic Procedures among Primary Care Physicians in Saudi Arabia

Joint and soft tissue injections in Irish primary care: a survey of GPs' attitudes and practices

BACKGROUND

Musculoskeletal conditions are common in primary care, causing significant morbidity. Intra-articular and soft tissue corticosteroid injections are commonly performed by GPs internationally. It is unknown how commonly they are performed by GPs in the Republic of Ireland.

AIM

To determine the frequency and type of joint and soft tissue injections performed by GPs in the Republic of Ireland and investigate factors affecting their use.

DESIGN & SETTING

A cross-sectional online questionnaire, which was based on previous international research, was devised for completion by GPs practising in the Republic of Ireland.

METHOD

GPs were invited to electronically complete a questionnaire on their practices and attitudes regarding joint and soft tissue injections.

RESULTS

A total of 147 of 204 GPs (72.1%) had performed an intra-articular or soft tissue injection in the preceding year. GPs who were principals or partners, male, or worked in a rural or mixed urban and rural practice setting were more likely to perform these procedures. The most common injection sites were the shoulder and knee. Participants were confident about performing joint and soft tissue injections. It was found that 80.4% had received prior training in this treatment modality, most commonly during their GP training programme. A prolonged wait for secondary care intervention, symptom duration, and symptom severity were factors that increased the likelihood of performing injections. Difficulty maintaining skills and medicolegal concerns were common barriers to performing joint and soft tissue injections.

CONCLUSION

Most GPs surveyed carried out joint and soft tissue injections, most commonly injecting the shoulder and knee. Irish GPs experience many of the same barriers to performing intra-articular injection as experienced internationally.

Referral patterns of Israeli pediatricians of common primary care office procedures

BACKGROUND

Pediatric primary care is the cornerstone of health care services for children. Performance of common office procedures is an integral part of primary care. Ideally, the community-based primary care pediatrician provides comprehensive health care services and only refers a small minority of patients for consultation. However, knowledge regarding Israeli pediatricians' practices of office procedures is scant.

OBJECTIVES

To describe primary care pediatricians' patterns in the provision of common office procedures and to analyze factors associated with performance or referral.

METHODS

DESIGN

Self-completed structured questionnaire consisting of 1) demographic variables; 2) practice characteristics description; 3) List of ten procedures (treatment of subungual hematoma, laceration suturing and adhesive closure, elbow subluxation/reduction , urinary bladder catheterization, supra-pubic aspiration, inguinal hernia reduction, umbilical granuloma and labial fusion treatment, and short lingual frenulum management) followed by questions regarding referral practice for each procedure; and 4) causes and indications for referral when relevant.

PARTICIPANTS

Primary care pediatricians attending anational pediatric conferences.

ANALYSIS

Descriptive statistics and association assessment.

RESULTS

The questionnaire was completed by 162 primary care pediatricians, 58.7 % male; mean age 53 ± 9 years, 88.4 % board certified. Of the respondents, 57 % worked in group practices and the remainder solo; salaried employees 68.2 %, independent contractors 31.8 %. Referral rate varied by procedure; least likely to be referred was labial fusion (7.7 %) and most likely was short lingual frenulum (81.3 %). For most procedures, the most frequent non-performance cause was lack of expertise followed by lack of appropriate conditions. The overall number of procedures in which the response selected was out-of-clinic referral was not associated with demographic or employment characteristics. However, association was found for certain specific procedures (e.g. experience with catheterization, gender with suturing and adhesive closure).

CONCLUSIONS

Many common office procedures are referred out of primary care pediatric community settings in Israel. Considerable variability was found among procedures. Lack of experience or lack of appropriate conditions were frequently reported causes for referral and need to be addressed in reducing unnecessary referral with its attendant costs and patient inconvenience. Possible approaches include updates in pediatric residency training, focused in-service training, time allocation and work environment reorganization.

Minor surgical procedures and musculoskeletal injections by primary care physicians - an Israeli experience

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