Acute low back pain management in primary care: a simulated patient approach.

Abstract:

BACKGROUND:Recent medical guidelines for acute low back pain (aLBP) are unevenly followed. Based on financial criteria or associated with a desirability bias, studies incompletely describe the actual management provided by general practitioners (GPs) in terms of diagnosis, treatment and prevention of progression towards chronicity. OBJECTIVE:To compare actual practices of French GPs for aLBP management with clinical guidelines. METHODS:A young simulated patient (SP) consulted, using a single scenario of aLBP, in 30 primary care practices in the Paris region. RESULTS:Heterogeneous data were collected according to the grid items: during the questioning, 29 GPs (97%) asked for age and 1 GP (3%) for pregnancy; during the clinical examination, 21 GPs (70%) asked for spinal stiffness and 3 GPs (10%) for cauda equina syndrome. Non-steroidal anti-inflammatory drugs were prescribed by 27 GPs (90%). Imaging (2 GPs or 7%) and physiotherapy (3 GPs or 10%) was rarely prescribed. A sick leave was prescribed by 22 GPs (73%). Twenty-seven GPs (90%) reassured the patient. CONCLUSION:aLBP management was in line with international guidelines in terms of clinical examination, physiotherapy and imaging prescriptions and some risk factors for chronicity were taken into account. However, patient questioning was brief, and drug and sick leave prescriptions did not meet international guidelines. The SP approach seems to be a useful tool for assessing actual GP practices.

journal_name

Fam Pract

journal_title

Family practice

authors

Lorenzo A,Schildt P,Lorenzo M,Falcoff H,Noel F

doi

10.1093/fampra/cmv030

subject

Has Abstract

pub_date

2015-08-01 00:00:00

pages

436-41

issue

4

eissn

0263-2136

issn

1460-2229

pii

cmv030

journal_volume

32

pub_type

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