Spruit Emely, Mol Marianne F, Bos P Koen, Bierma-Zeinstra Sita M A, Krastman Patrick, Runhaar Jos
Department of General Practice, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands.
Department of Orthopaedic Surgery, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands.
J Clin Med. 2020 Jun 16;9(6):1880. doi: 10.3390/jcm9061880.
General practitioners (GPs) are qualified and trained to administer therapeutic musculoskeletal injections when indicated. However, it is unknown to what extend Dutch GPs feel competent to administer these injections in clinical practice. Reluctance among GPs to inject might lead to unnecessary and costly referral to secondary care. An online and offline questionnaire was spread among Dutch GPs, querying demographics, GPs' self-assessment of injection competence, the number of administered/referred injections and management strategy for musculoskeletal injections. A total of 355 GPs responded. In total, 81% of the GPs considered themselves competent in administering musculoskeletal injections. Self-assessed incompetent GPs performed less injections the last month than self-assessed competent GPs (1.2 ± 1.4 vs 4.8 ± 4.6 injections, P < 0.001). Additionally, they referred four times more often to a colleague GP (0.4 ± 1.0 vs 0.1 ± 0.6 injections per month, P < 0.001) and twice as often to secondary care (1.0 ± 1.3 vs 0.5 ± 0.9 injections per month, P = 0.001). Self-assessed incompetence was associated with female sex (OR [95% CI] = 4.94 [2.39, 10.21]) and part-time work (OR [95% CI] = 2.58 [1.43, 4.66]). The most frequently addressed barriers were a lack of confidence in injection skills, lack of practical training, and uncertainty about the effectiveness and diagnosis of musculoskeletal injections. Although most GPs considered themselves competent to administer musculoskeletal injections, the referral rate to secondary care for several injections was strikingly high. To decrease secondary care referrals, addressing some of the most frequently indicated barriers is highly recommended.
全科医生（GPs）具备资质且经过培训，在有指征时可进行治疗性肌肉骨骼注射。然而，荷兰全科医生在临床实践中对进行这些注射的胜任程度究竟如何尚不清楚。全科医生不愿进行注射可能会导致不必要且费用高昂的二级医疗转诊。一份线上和线下问卷在荷兰全科医生中展开，询问人口统计学信息、全科医生对注射能力的自我评估、已进行/转诊的注射数量以及肌肉骨骼注射的管理策略。共有355名全科医生做出回应。总体而言，81%的全科医生认为自己有能力进行肌肉骨骼注射。自我评估为不胜任的全科医生在上个月进行的注射比自我评估为胜任的全科医生少（1.2±1.4次注射与4.8±4.6次注射，P<0.001）。此外，他们向同事全科医生转诊的频率高出四倍（每月0.4±1.0次注射与0.1±0.6次注射，P<0.001），向二级医疗转诊的频率高出一倍（每月1.0±1.3次注射与0.5±0.9次注射，P = 0.001）。自我评估为不胜任与女性性别（比值比[95%置信区间]=4.94[2.39, 10.21]）和兼职工作（比值比[95%置信区间]=2.58[1.43, 4.66]）相关。最常提及的障碍是对注射技能缺乏信心、缺乏实践培训以及对肌肉骨骼注射的有效性和诊断存在不确定性。尽管大多数全科医生认为自己有能力进行肌肉骨骼注射，但几种注射向二级医疗的转诊率却高得惊人。为了减少向二级医疗的转诊，强烈建议解决一些最常指出的障碍。
