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Treating hand fractures: population-based study of acute health care use in British Columbia
Lynne M Feehan1, Samuel S Sheps
1University of British Columbia in Vancouver. Feehan@interchange.ubc.ca
Insights
Most hand fractures in British Columbia are treated conservatively by primary care physicians as nonemergencies. Specialist surgeons manage complex cases quickly, and rural patients have higher admission rates.
Area of Science:
- Orthopedic Surgery
- Public Health
- Health Services Research
Background:
- Hand fractures are common injuries requiring acute healthcare services.
- Understanding trends in their management is crucial for optimizing patient care and resource allocation.
Purpose of the Study:
- To examine trends in the utilization of acute healthcare services for hand fractures.
- To analyze management patterns across diverse medical settings in British Columbia.
Main Methods:
- Retrospective review of the British Columbia Linked Health Dataset.
- Inclusion of 72,481 residents treated for hand fractures between 1996 and 2001.
- Analysis of initial treatment, hospital use, and geographic variations.
Main Results:
- 97% of patients received outpatient treatment, with 54% in nonhospital settings and 70% by primary care physicians.
- 90% of fractures were managed conservatively; 10% of complex cases were treated by specialists within 2 days.
- Rural patients exhibited higher hospital admission rates (RR 2.1) for hand fractures.
Conclusions:
- Hand fractures are predominantly managed as nonemergencies by primary care physicians, unlike other fractures requiring specialist care.
- Conservative management is standard, with timely specialist intervention for complex cases.
- Enhanced training for primary care physicians in acute hand fracture management is recommended for consistent, high-quality care across Canada.
Objective:
To examine trends in use of acute health care services for hand fractures in a large diverse population across a range of medical settings.
Design:
Retrospective review of data from the British Columbia Linked Health Dataset on patients who had been treated for hand fractures between May 1, 1996, and April 30, 2001.
Setting:
British Columbia.
Participants:
A total of 72 481 British Columbia residents identified from the British Columbia Linked Health Dataset as having received treatment for hand fractures.
Main Outcome Measures:
Initial treatment for fractures (who had provided treatment and where had the treatment taken place) and hospital use (type of hospital, physician responsible, wait time, length of stay,geographic variation).
Results:
Almost all patients (97%) with hand fractures received initial treatment as outpatients. Just over half these patients (54%) received initial care in nonhospital settings, and more than two-thirds (70%) received initial care from primary care physicians. By far most patients (90%) were treated conservatively without surgical intervention. The few patients with more complicated hand fractures (10%) were most commonly treated in day surgery settings by specialist surgeons within 2 days of first presentation. Patients in the more rural, isolated,northern region of British Columbia had higher hospital admission rates (relative risk 2.1) for hand fractures than patients in other regions did.
Conclusion:
In contrast to other common fracture injuries that are routinely managed by specialist surgeons,most hand fractures in BC were managed initially as nonemergency medical problems by primary care physicians. Almost all patients were treated conservatively without surgical intervention. The few patients with more complicated hand fractures were referred to and treated quickly by specialist surgeons. Focused training and continuing education opportunities for primary care physicians on new approaches to management of acute hand fractures will ensure that patients with hand fractures in British Columbia and the whole of Canada continue to benefit from appropriate management by primary care physicians.
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