基层医疗中腰痛的管理 - 其质量是否可接受：意大利南蒂罗尔 25 家基层医疗机构的观察性研究。
Management of low back pain in general practice - is it of acceptable quality: an observational study among 25 general practices in South Tyrol (Italy).
机构信息
Institute of General Practice, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
出版信息
BMC Fam Pract. 2013 Oct 4;14:148. doi: 10.1186/1471-2296-14-148.
BACKGROUND
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.
METHODS
In 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.
RESULTS
Twenty-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.
CONCLUSIONS
Our 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.
背景
有几项指南专门针对腰痛（LBP）的管理，但很少有研究评估全科医生在提供腰痛治疗时对这些指南的遵循情况。本研究旨在分析意大利全科医生对腰痛的管理，并将其与指南建议进行比较。
方法
在这项观察性研究中，在 8 周内因腰痛就诊的所有患者，至少在 4 周内接受症状、诊断和治疗干预的监测。根据指南建议制定的预定义质量指标来评估腰痛的管理情况。
结果
114 名符合条件的全科医生中有 25 名参与了该研究，共代表 43012 名注册患者。在 475 名接受了 4 周监测的腰痛患者中，55.8%被诊断为急性腰痛，13.5%为慢性腰痛，17.1%为急性坐骨神经痛，12.6%为慢性坐骨神经痛；76.0%的患者未进行任何技术检查，21.7%进行了 X 光检查，5.5%进行了 MRI 检查，4%进行了 CT 检查；20.4%的患者被转诊至二级医疗机构；93.3%的患者接受了某种药物治疗。在接受药物治疗的患者中，88.3%为 NSAID，6.3%为扑热息痛，10.4%为扑热息痛联合可待因，9%为肌肉松弛剂。当开处物理治疗（17.1%）时，主要是按摩。只有不到 50%的全科医生（部分）遵循当地制定的指南，而其余医生似乎根本不遵循指南。
结论
本研究显示，全科医生对腰痛的管理与当前指南存在明显偏差，并指出了两种不同类型的偏差者：部分遵循指南的医生和完全不遵循指南的医生。进一步的研究应评估这两种类型的偏差是否可以通过不同的教育重点来解决，即分别针对知识和态度。
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