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April/May 2010 (vol. 06/6)
GPs do not follow LBP guidelines
A large-scale analysis of primary healthcare of patients with low back pain (LBP) found that GPs frequently did not follow international best-practice guidelines and that patient outcomes were often suboptimal. The study, carried out in Australia between 2005 and 2008, mapped 3,533 GP patient visits with a new episode of LBP. More than one quarter (25.3%) of patients were referred for imaging, even though this is generally discouraged. Similarly, while it is generally recommended that initial care should focus on advice and simple analgesic medication (eg paracetamol), only 20% of patients received the former and 17% the latter. Where paracetamol was prescribed, only one-third of patients were given the correct dose. Doctors tended instead to prescribe non-steroidal anti-inflammatory drugs (37%) and opioids (20%). A comparison of referrals in the period 2001–2004 found that GP practice had not generally improved since the release of an Australian LBP guideline in 2004.
Archives of Internal Medicine 2010; 170(3): 271–277. http://archinte.jamanetwork.com/article.aspx?articleid=415588
Occupational Health at Work April/May 2010 (vol. 06/6) pp49