Roberts C, Adebajo A O, Long S
Department of Medical Education, University of Sheffield, Coleridge House, Sheffield S5 7AU, UK.
Rheumatology (Oxford). 2002 May;41(5):503-8. doi: 10.1093/rheumatology/41.5.503.
To determine the support services general practitioners (GPs) need when working with patients who have musculoskeletal problems and their educational needs in order to deliver an improved service.
GPs (n=446) on the Sheffield and Barnsley principal lists were sent a questionnaire (53.8% response rate). Semistructured interviews of a purposive sample of 10 GPs were analysed qualitatively to increase understanding of the research objectives.
GPs were self-confident in managing common musculoskeletal conditions such as gout (86% of GPs who replied), back pain (69%), osteoarthritis (62%) and sporting injuries (58%) entirely within the surgery. Despite high levels of confidence in diagnosing non-specific pain syndromes, 68% of GPs would refer to a rheumatologist. Most GPs (68%) were happy with their current referral rates to physiotherapists and 65% of GPs in this sample provided a personal injection service. Reduction of inappropriate prescribing of non-steroidal anti-inflammatory drugs would be helped by better patient education materials on treatments (90%) and more resources for the primary care physiotherapy service (85%). Half of the GPs had had specific musculoskeletal training within the last 5 yr. Half of the GPs planned to update their knowledge and skills in the next year, 64% of these preferring a taught interactive course, 50% wanting to sit in with a consultant in clinic and 46% preferring to learn as part of a personal learning plan.
GPs feel confident managing the majority of musculoskeletal conditions within the surgery provided they have adequate support in terms of opportunities for appropriate education, particularly joint injection techniques, ongoing consultant support for complex cases with poor outcomes, particularly non-specific pain syndromes, adequate access to physiotherapy, and a multidisciplinary approach to pain control and inappropriate prescribing.
确定全科医生（GPs）在为患有肌肉骨骼问题的患者提供服务时所需的支持服务及其教育需求，以便提供更好的服务。
向谢菲尔德和巴恩斯利主要名单上的全科医生（n = 446）发送问卷（回复率为53.8%）。对10名全科医生的目的抽样进行半结构化访谈，并进行定性分析，以加深对研究目标的理解。
全科医生对在诊所内完全管理常见的肌肉骨骼疾病充满自信，如痛风（回复的全科医生中有86%）、背痛（69%）、骨关节炎（62%）和运动损伤（58%）。尽管对诊断非特异性疼痛综合征有很高的信心，但68%的全科医生会转诊给风湿病专家。大多数全科医生（68%）对目前转介给物理治疗师的比例感到满意，该样本中65%的全科医生提供个人注射服务。更好的治疗患者教育材料（90%）和更多的初级保健物理治疗服务资源（85%）将有助于减少非甾体抗炎药的不适当处方。一半的全科医生在过去5年内接受过特定的肌肉骨骼培训。一半的全科医生计划在明年更新他们的知识和技能，其中64%更喜欢参加有授课的互动课程，50%希望在诊所与顾问一起坐诊，46%更喜欢作为个人学习计划的一部分进行学习。
全科医生认为，如果在适当的教育机会方面，特别是关节注射技术方面得到充分支持，对于复杂病例尤其是非特异性疼痛综合征有持续的顾问支持，有足够的物理治疗途径，以及采用多学科方法控制疼痛和减少不适当处方，他们有信心在诊所内管理大多数肌肉骨骼疾病。
