Ten-year survey reveals differences in GP management of neck and back pain
- 209 Downloads
Clinical guidelines provide similar recommendations for the management of new neck pain and low back pain (LBP) but it is unclear if general practitioner’s (GP) care is similar. While GP’s management of LBP is well documented, little is known about GP’s management of neck pain. We aimed to describe GP’s management of new neck pain and compare this to GP’s management of new LBP in Australia between April 2000 and March 2010.
All GP–patient encounters for a new (i.e. first visit to any medical practitioner) neck pain or LBP problem were compared in terms of treatment delivered, referral patterns and requests for laboratory and imaging investigations.
General practitioners in Australia have managed new neck pain and LBP problems at a rate of 3.1 and 5.8 per 1,000 GP–patient encounters, respectively. GP’s primarily utilised medications, in particular non-steroidal anti-inflammatory drugs, to manage new neck and LBP problems and referred approximately 25% of all patients for imaging. Patients with new neck pain are more frequently managed using physical treatments and were referred more often to allied health professionals and specialists. In comparison, patients with new LBP were managed more frequently with medication, advice, provision of a sickness certificate and ordering of pathology tests.
This is the first time GP management of a new episode of neck pain has been documented using a nationally representative sample and it is also the first time that the management of back and neck pain has been compared. Despite guidelines endorsing a similar approach for the management of new neck pain and LBP, in actual clinical practice Australian GPs manage these two conditions differently.
KeywordsPrimary care General practice Low back pain Neck pain
Conflict of interest
None of the authors involved in the preparation of this manuscript have any potential, perceived or real conflict to disclose.
- 3.Coole C, Watson P, Drummond A (2010) Work problems due to low back pain: what do GPs do? A questionnaire survey. Fam Prac 27:31–37Google Scholar
- 4.Australian Government Department of Health and Aging (2010) What Medicare covers (updated 7 Oct, 2010; cited 2011 31 Aug). http://www.medicareaustralia.gov.au/public/claims/what-cover.jsp
- 7.Australian Acute Musculoskeletal Pain Guidelines Group (2003) Evidence-based management of acute musculoskeletal pain. National Health and Medical Research Council, AustraliaGoogle Scholar
- 9.Australian Medicines Handbook Pty Ltd and Health Communication Network (2010) Australian medicines handbookGoogle Scholar
- 12.Classification Committee of the World Organization of Family Doctors (1998) ICPC-2: international classification of primary care, 2nd edn. Oxford University Press, OxfordGoogle Scholar
- 13.Britt H (1997) A new coding tool for computerised clinical systems in primary care-ICPC plus. Aust Fam Phys 26(Suppl 2):S79–S82Google Scholar
- 14.Britt H, Miller G, Charles J, Henderson J, Bayram C, Pan Y et al (2010) General practice activity in Australia 2009–10. Australian Institute of Health and Welfare, Canberra (contract No.: Cat. no. GEP 27)Google Scholar
- 15.World Health Organization Collaborating Centre for Drug Statistics Methodology (1997) Anatomical therapeutic chemical (ATC) classification index with defined daily doses (DDDs), Jan 1998 edn. World Health OrganisationGoogle Scholar
- 16.Australian Bureau of Statistics (2008) Australian standard geographical classification. Australian Institute of Health and WelfareGoogle Scholar
- 17.Britt H, Miller G, Bayram C (2007) The quality of data on general practice: a discussion of BEACH reliability and validity. Aust Fam Phys 36(1–2):36–40Google Scholar
- 18.Britt H (1998) Reliability of central coding of patient reasons for encounter in general practice, using the International Classification of Primary Care. Inform Prim Care 3–7Google Scholar
- 19.Britt H, Miller G, Charles J, Henderson J, Bayram C, Valenti L, et al (2010) General practice activity in Australia 2000–01 to 2009–10: 10 year data tables. http://www.aihw.gov.au/publications/index.cfm/title/12119
- 20.The Family Medicine Research Centre (2010) The BEACH project, bettering the evaluation and care of health (internet) (updated 14 July 2010 cited 2010). http://www.fmrc.org.au/beach.htm
- 21.Australian Government Department of Health and Ageing (2009) Medicare statistics, March quarter 2009, Group B tables. Australian Government Department of Health and Ageing, Canberra. www.health.gov.au/internet/main/publishing.nsf/Content/medstat-mar09-tablesb
- 22.Binder AI (2008) Neck pain. Clin Evid (Online)Google Scholar
- 26.Schers H, Braspenning J, Drijver R, Wensing M, Grol R (2000) Low back pain in general practice: reported management and reasons for not adhering to the guidelines in the Netherlands. Br J Gen Pract 50:640–644Google Scholar
- 32.Roelofs PD, Deyo RA, Koes BW, Scholten RJ, van Tulder MW (2008) Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database Syst Rev 1:CD000396Google Scholar
- 33.Griffin M (1998) Epidemiology of nonsteroidal anti-inflammatory drug-associated gastrointestinal injury. Am J Med 104(3A):23S–29S, 41S–42SGoogle Scholar
- 34.Kravitz R, Epstein R, Feldman M, Franz C, Azari R, Wilkes M et al (2005) Influence of Patients’ Requests for Direct-to-Consumer Advertised Antidepressants: A Randomized Controlled Trial JAMA. 293(16):1995–2002Google Scholar
- 35.Weissman J, Blumenthal D, Silk A, Newman M, Zapert K, Leitman R, et al (2004) Physicians report on patient encounters involving direct-to-consumer advertising. Health Affairs. doi: 10.1377/hlthaff.W4.219
- 36.Chou R, Qaseem A, Snow V, Casey D, Cross J, Shekelle P et al (2007) Clinical Efficacy Assessment Subcommittee of the American College of Physicians American College of Physicians American Pain Society Low back pain Guidelines Panel Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 147(7):478–491PubMedGoogle Scholar
- 37.Bekkering GE, van Tulder MW, Hendriks EJ, Koopmanschap MA, Knol DL, Bouter LM et al (2005) Implementation of clinical guidelines on physical therapy for patients with low back pain: randomized trial comparing patient outcomes after a standard and active implementation strategy. Phys Ther 85(6):544–555PubMedGoogle Scholar