Management of Hallux Valgus in General Practice in Australia.

Abstract

To describe the management of hallux valgus by general practitioners (GPs) in Australia. We analyzed data from the Bettering the Evaluation and Care of Health program from April 2000 to March 2016. Patient and GP encounter characteristics were extracted. Hallux valgus encounters were identified using the International Classification of Primary Care, Version 2 Plus terms hallux valgus and bunion. Data were summarized using descriptive statistics and 95% confidence intervals around point estimates. The data set included 1,568,100 patient-encounter records among which hallux valgus was managed 658 times (4.2 management occasions per 10,000 encounters). This management rate extrapolates to an estimated 60,000 GP-patient encounters across Australia in the most recent year data were available (from 2015 to 2016). The management rate was 3 times higher in female compared to male patients and was most frequent among patients ages 45-64 years. Hallux valgus was most frequently managed by referral to orthopedic surgeons (28 per 100 management occasions), counseling or advice (25 per 100), and referral to podiatrists (16 per 100). Pharmacologic management was also frequently used (20 per 100) and primarily involved prescription of nonsteroidal antiinflammatory drugs (7 per 100). Hallux valgus is a commonly encountered problem in Australian general practice and is mostly managed by provision of advice and referral to orthopedic surgeons and podiatrists. Further research is required to examine the factors that influence the selection of surgical and nonsurgical treatment pathways by GPs and their comparative effectiveness.