Abstract
BackgroundThere are several guidelines dealing with the management of low back pain (LBP), but only few studies on the quality of care provided within General Practices as judged against those guidelines.The objective of this study is to analyse the management of LBP in Italian General Practice and compare it with guideline recommendations.MethodsIn this observational study, all patients visiting their General Practitioners (GPs) for treatment of LBP within a 8-week period were monitored for at least four weeks with regard to symptoms and diagnostic and therapeutic interventions. Management of LBP was judged by pre-defined quality indicators based on guideline recommendations.ResultsTwenty-five of 114 eligible GPs participated in the study, representing a total of 43,012 registered patients. Of the 475 patients complaining of LBP and monitored for four weeks, 55.8% were diagnosed as having acute lumbar pain, 13.5% chronic lumbar pain, 17.1% acute sciatica, and 12.6% chronic sciatica; 76.0% underwent no technical investigations, 21.7% underwent x-rays, 5.5% MRI and 4% CT scans; 20.4% were referred to secondary care; 93.3% of all patients received some medication. In those receiving a medication, in 88.3% it was an NSAID, in 6.3% Paracetamol, in 10.4% Paracetamol combined with Codeine, and in 9% a muscle relaxants. When physiotherapy was prescribed (17,1%), it was mostly massage. Hardly more than 50% of GPs (partially) followed locally established guidelines, while the remainder seemed not to follow guidelines at all.ConclusionsOur study reveals gross deviations of GP management of LBP from current guidelines and points to two different types of deviators: those who partially follow guidelines, and those who do not follow them at all. Further research should evaluate whether these two types of deviation are best addressed by different foci of education, i.e. on knowledge versus attitudes, respectively.
Highlights
There are several guidelines dealing with the management of low back pain (LBP), but only few studies on the quality of care provided within General Practices as judged against those guidelines
The aim of this paper is to show how LBP is managed within Family Practices in a gate-keeper system in South Tyrol in Northern Italy, focusing on diagnostic investigations and treatment, and comparing these procedures to actual guideline recommendations
Of the invited 114 eligible General practitioner (GP) in this region, the first 25 GPs applying for participation were chosen
Summary
There are several guidelines dealing with the management of low back pain (LBP), but only few studies on the quality of care provided within General Practices as judged against those guidelines. The objective of this study is to analyse the management of LBP in Italian General Practice and compare it with guideline recommendations. Low back pain (LBP) is a common ailment among patients visiting GPs [1]. Studies of the last two decades have shown that traditional treatment of LBP, focusing on injections and (bed)rest, may contribute to chronification and its devastating individual and macroeconomic sequelae. Current guidelines [15], including those in use in South Tyrol [16,17], suggest to recommend paracetamol as the analgetic drug of first choice, followed by non-steroidal anti-inflammatory drugs (NSAIDs). Because of the mostly benign nature of the condition, only in few cases diagnostic imaging or specialist involvement are indicated
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