MANAGEMENT OF COMMON MUSCULOSKELETAL PROBLEMS - A SURVEY OF ONTARIO PRIMARY-CARE PHYSICIANS

Background: In Canada, primary care physicians manage most musculoskel etal problems. However, their training in this area is limited, and so me aspects of management may be suboptimal. This study was conducted t o examine primary care physicians' management of 3 common musculoskele tal problems, ascertain the determinants of management and compare man agement with thar recommended by a current practice panel. Methods: A stratified computer-generated random sample of 798 Ontario members of the College of Family Physicians of Canada received a self-administere d questionnaire by mail. Respondents selected various items in the man agement of 3 hypothetical patients: a 77-year-old woman with a shoulde r problem, a 64-year-old man with osteoarthritis of the knee and a 30- year-old man with an acutely hot, swollen knee. Scores reflecting the proportion of recommended investigations, interventions and referrals selected for each scenario were calculated and examined for their asso ciation with physician and practice characteristics and physician atti tudes. Results: The response rate was 68.3% (529/775 eligible physicia ns). For the shoulder problem, all of the recommended items were chose n by the majority of respondents. However, of the items not recommende d, ordering blood tests was selected by almost half (242 [45.7%]) as w as prescribing an NSAID (236 [44.7%]). For the knee osteoarthritis, th e majority of respondents chose the recommended items except exercise (selected by only 175 [33.1%]). Of the items not recommended, tests we re chosen by about half of the respondents and inappropriate referrals (chiefly for orthopedic surgery) were chosen by a quarter. For the ac utely hot knee, the majority of physicians chose all of the recommende d items except use of ice or heat (selected by only 188 [35.6%]). Alth ough most (415 [78.5%]) of the respondents selected the recommended jo int aspiration for this scenario, 84 (15.9%) omitted this investigatio n or referral to a specialist. The selection of recommended items was strongly associated with training in musculoskeletal specialties durin g medical school and residency. Interpretation: Primary care physician s' management of 3 common musculoskeletal problems was for the most pa rt in accord with panel recommendations. However, the unnecessary use of diagnostic tests, inappropriate prescribing of NSAIDs, low use of p atient-centred options such as exercise, and lack of diagnostic suspic ion of infectious arthritis are cause for concern. The results point t o the need for increased exposure to musculoskeletal problems during u ndergraduate and residency training and in continuing medical educatio n.