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How do general practitioners manage hip problems in adults?
S M Bierma-Zeinstra1, S Lipschart, K H Njoo
1Department of General Practice, Erasmus University, Rotterdam, The Netherlands.
Objective:
To investigate the medical management, and its consistency and determinants, of hip problems in adult patients.
Setting:
General practice, The Netherlands.
Design:
Observational study based on four "paper patients" and on computerised patients records (CPRs) of 400 patients (20 per general practitioner), aged 50 years and over, with new hip problems.
Subjects:
20 general practitioners.
Main Outcome Measures:
Examination, diagnosis and treatment of hip patients.
Results:
Medical history and physical examination consisted mainly of questions concerning pain localisation and onset, and examining passive hip motion. The paper patients, except for the one with alarming symptoms, and the CPRs showed high variation in management between general practitioners, particularly for medication prescription and X-ray requests. Main factors influencing medical management were patients' age, number of visits and attitude of the individual general practitioner. A specific diagnosis was registered for only 32% of the 400 patients. The diagnosis osteoarthritis varied greatly between general practitioners even after adjustment for patients' age, gender and number of visits. Patients with osteoarthritis were infrequently referred to physical therapy and received nonsteroidal anti-inflammatory drugs (NSAIDs) more often than paracetamol.
Conclusion:
Diagnosis and treatment of hip problems varies widely between general practitioners. Treatment of patients with osteoarthritis is inconsistent with published recommendations.