Variation in diagnosis and management of common foot problems by GPs

BACKGROUND

There are indications that the diagnosis and management of common foot problems vary widely in general practice.

OBJECTIVES

Our aim was to explore the variation of GPs' diagnosis and management of common foot problems and the possible correlation between GPs' characteristics and their competence to diagnose correctly.

METHODS

In a cross-sectional design, 90 GPs in The Netherlands were invited to complete a questionnaire regarding seven vignettes with common foot problems (hallux valgus, hallux rigidus, fasciitis plantaris, tarsal tunnel syndrome, metatarsalgia, corns and calluses, and rheumatoid arthritis), combined with questions covering diagnoses, management options and some GP characteristics.

RESULTS

A total of 72 GPs responded (80%). They most often diagnosed hallux valgus (79%) and rheumatoid arthritis (86%) correctly, and most often hallux rigidus (37%) and tarsal tunnel syndrome (74%) incorrectly. GP characteristics did not correlate with their competence in diagnosing. The most frequently suggested management was referral to a podiatrist. The referral rate to medical specialists was low, except in the case of rheumatoid arthritis (79%).

CONCLUSIONS

More than half of the GPs were competent in diagnosing vignettes of common foot problems. This diagnostic competence showed great variation and was not associated independently with GP characteristics. Educational programmes are recommended. Management showed less variation and often included referral to podiatrists. Further research into the effectiveness of specific treatments for different foot problems is recommended.

Health care utilisation by older people with non-traumatic foot complaints. What makes the difference?

OBJECTIVES

To determine the factors associated with the type of health care chosen by elderly people suffering from non-traumatic foot complaints.

DESIGN

Cross-sectional mailed survey.

SETTING

Population-based random sample of 7200 people aged > or = 65 years in The Netherlands.

SUBJECTS

1130 people > or = 65 years with non-traumatic foot complaints for 4 weeks or more.

MAIN OUTCOME MEASURES

Use of non-(para)medical care (i.e. no care at all, self-care and chiropodial care) versus (para)medical care (i.e. care given by paramedical personnel, general practitioners and medical specialists).

RESULTS

Six of every 10 respondents sought (para)medical care, half of these visited the GP. Factors associated with the use of (para)medical care were foot-related limitations (adj OR 3.18; 95% CI 2.26-4.46), painful feet (adj OR 1.55; 1.09-2.23), and foot osteoarthritis (adj OR 1.88; 1.32-2.68). (Para)medical care was sought less often than non-(para)medical care for forefoot complaints (adj OR 0.56; 0.41-0.76).

CONCLUSIONS

Elderly people with non-traumatic foot complaints did not seem to underreport their problems to (para)medical care providers. Furthermore, they appeared to select the appropriate type of care. Future studies will have to assess the effectiveness of the care provided.

Prescription of antibiotics and prescribers' characteristics. A study into prescription of antibiotics in upper respiratory tract infections in general practice

There is a growing concern about rational prescribing of antibiotics. That is why a secondary analysis of prescribing antibiotics in upper respiratory tract infections has been conducted by means of a nationwide study of morbidity and interventions in The Netherlands. The mean percentage of antibiotic prescriptions varied from about 20% for acute otitis media and acute upper respiratory tract infections to about 70% for sinusitis and tonsillitis. Only attitude--toward prescribing antibiotics in sore throat--and years of settlement were important predictor variables. The other characteristics studied--type of practice, list size, frequency of use of Het Farmacotherapeutisch Kompas, containing national pharmacotherapeutical guidelines, and urbanization level were not. The importance of attitude, however, was less for general practitioners who went into practice after 1975. This means that the influence of a personal characteristic as attitude might have become less influential since the introduction of vocational training for general practice.