A before and after study of the impact of academic detailing on the use of diagnostic imaging for shoulder complaints in general practice
Tóm tắt
The aim of this study was to assess the impact that Academic Detailing (AD) had on General Practitioners' use of diagnostic imaging for shoulder complaints in general practice and their knowledge and confidence to manage shoulder pain. One-to-one Academic Detailing (AD) for management of shoulder pain was delivered to 87 General Practitioners (GPs) in metropolitan Adelaide, South Australia, together with locally developed clinical guidelines and a video/DVD on how to examine the shoulder. Three months after the initial AD a further small group or an individual follow up session was offered. A 10-item questionnaire to assess knowledge about the shoulders was administered before, immediately after, and 3 months after AD, together with questions to assess confidence to manage shoulder complaints. The number of requests for plain film (X-ray) and ultrasound (US) imaging of the shoulder was obtained for the intervention group as well as a random comparison group of 90 GP's from the same two Divisions. The change in the rate of requests was assessed using a log Poisson GEE with adjustment for clustering at the practice level. A linear mixed effects model was used to analyse changes in knowledge. In an average week 54% of GPs reported seeing fewer than 6 patients with shoulder problems. Mean (SD) GP knowledge score before, immediately after and 3-months after AD, was 6.2/10 (1.5); 8.6/10 (0.96) and; 7.2/10 (1.5) respectively (p < 0.0001). Three months after AD, GPs reported feeling able to take a more meaningful history, more confident managing shoulder pain, and felt their management of shoulder pain had improved. Requests for ultrasound imaging were approximately 43.8% higher in the period 2 years before detailing compared to six months after detailing (p < 0.0001), but an upward trend toward baseline was observed in the period 6 months to 1 year after AD. There was no statistically significant change in the rate of requests from before to after AD for plain-radiographs (p = 0.11). No significant changes in the rate of requests over time were observed in the control groups. These results provide evidence that AD together with education materials and guidelines can improve GPs' knowledge and confidence to manage shoulder problems and reduce the use of imaging, at least in the short term.
Tài liệu tham khảo
Mitchell C, Adebajo A, Hay E, Carr A: Shoulder pain: diagnosis and management in general practice. BMJ. 2005, 331: 1124-1128. 10.1136/bmj.331.7525.1124.
van der Heijden GJ, van der Windt DA, Kleijnen J, Koes BW, Bouter LM: Steroid injections for shoulder disorders: a systematic review of randomised controlled trials. Br J Gen Pract. 1996, 46: 309-316.
van der Heijden GJ: Shoulder disorders: a state of the art review. Bailliere’s Clinical Rheumatology. Edited by: Croft P, Brooks PM. 1999, 13: 287-309. 10.1053/berh.1999.0021.
van der Windt DA, Koes BW, Boeke AJ, Deville W, De Jong BA, Bouter LM: Shoulder disorders in general practice: the prognostic indicators of outcome. Br J Gen Pract. 1996, 46 (410): 519-523.
Stevenson JH, Trojian T: Evaluation of shoulder pain. The Journal of Family Practice. 2002, 51 (7): 605-611.
Broadhurst N, Baghurst T, MacLaren S: Ultrasound imaging for shoulder pain in general practice. Aust Fam Physician. 2004, 33 (8): 668-669.
Broadhurst NA, Gialamas A, McElroy HJ, Beilby JJ: How do Australian GP’s manage shoulder dysfunction?. Aust Fam Physician. 2004, 33 (10): 861-2, 864.
Hoffman JR, Wolfson AB, Todd K, Mower WR: Selective cervical spine radiography in blunt trauma: methodology of the national Emergency X-radiography Utilizatio Study (NEXUS). Ann Emerg Med. 1998, 32 (4): 461-469. 10.1016/S0196-0644(98)70176-3.
Spitzer WO, Skovron ML, Salmi LR, Cassidy JD, Duranceau J, Suissa S, Zeiss E: Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining "whiplash" and its management. Spine. 1995, 20 (8 Suppl): 1S-73S.
Stiell IG, Greenberg GH, McKnight RD, Nair RC, McDowell I, Worthington JR: A study to develop clinical decision rules for the use of radiography in acute ankle injuries. Ann Emerg Med. 1992, 21 (4): 384-390. 10.1016/S0196-0644(05)82656-3.
Stiell IG, Greenberg GH, Wells GA, McKnight RD, Cwinn AA, Cacciotti T, McDowell I, Smith NA: Derivation of a decision rule for the use of radiography in acute knee injuries. Ann Emerg Med. 1995, 26 (4): 405-413. 10.1016/S0196-0644(95)70106-0.
Stiell IG, Wells GA, Vandemheen KL, Clement CM, Lesiuk H, De Maio VJ, Laupacis A, Schull M, McKnight RD, Verbeek R, Brison R, Cass D, Dreyer J, Eisenhauer MA, Greenberg GH, MacPhail I, Morrison L, Reardon M, Worthington J: The Canadian C-Spine Rule for radiography in alert and stable trauma patients. JAMA. 2001, 286 (15): 1841-1848. 10.1001/jama.286.15.1841.
The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2296/8/12/prepub