Interdisziplinäre Kommunikation bei der Überweisung von Patienten mit Kreuzschmerzen vom Hausarzt zum Orthopäden

Abstract

Communication and exchange of clinical findings between general practitioners and orthopaedic surgeons. A retrospective observational study Abstract der Dissertation in Englisch: Introduction. Low back pain is a frequent reason for consultation in general practice. Many patients are treated in cooperation with an orthopaedic surgeon which requires an effective exchange of information. The aim of this study was to investigate communication between general practitioners (GPs) and orthopaedic surgeons. Material and methods. In this retrospective observational study, we analyzed referrals from GPs and corresponding response letters from orthopaedic surgeons. GPs were asked to provide reasons for referral and rated the quality of the response letters. Results. A total of 12 from 82 GPs from the teaching network of the Medical School of Göttingen participated in the study. Of 911 referrals to ambulatory orthopaedic surgeons within 3 month, 34% (n =312) were referred for low back pain. GPs provided little information beyond a diagnosis on the referral form, contrary to their self perception. Most referrals (61%) were patient initiated and most of them were considered at risk for chronification (72%) by the referring GP. Despite a formal obligation to report back GPs received for only one third (114/312) of the patients a response letter. GPs rated most of them as satisfactory; however 59% were unsatisfied with the treatment recommendations. Only 10 % of the letters contained a psychosocial history. The information provided in the orthopaedic response letters was heterogeneous and fulfilled only partly the criteria of the Interdisciplinary Society for Orthopaedic Pain Management. Conclusion. Incomplete and scrimp information on referral forms from GPs and a high non-response rate from orthopaedic surgeons suggest a lack of interest to communicate about the patient rather than a real communication problem. This might explain the satisfaction of GPs with the orthopaedic response letters despite lacking information. The GPs dissatisfaction with the treatment recommendations reflects the limited treatment option for chronic low back pain in ambulatory care.