Mohanty Sudipta, Mohanty Aditya, Fainstad Brandon, Parks Edward Ted, W Y Irene
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
Division of General Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA.
J Gen Intern Med. 2025 Apr 17. doi: 10.1007/s11606-025-09490-x.
Large joint and bursa steroid injections and aspirations are useful for many musculoskeletal pathologies commonly seen in primary care. However, there is lack of clarity on whether primary care physicians should perform these procedures themselves or refer to specialists. This study reviews the existing literature to explore the impact of primary care physicians performing these procedures. We performed a PubMed search using two search protocols to identify relevant articles. Two investigators independently screened articles for relevance via specific inclusion and exclusion criteria. Two additional investigators resolved disagreements. We also hand-searched references in all articles. The search methods identified 257 articles, of which 132 met inclusion criteria. Agreement was almost perfect for results from Protocol 1 (kappa = 0.96, 95% CI 0.91-0.99) and substantial for Protocol 2 (kappa = 0.77, 95% CI 0.60-0.94). The results reveal data on primary care physicians performing large joint and bursa steroid injections and aspirations including current trends, management and procedural techniques, outcomes, safety and complication rates, patients' access to treatments, cost differences between primary care versus subspecialty performed procedures, feasibility concerns, training, and patients' perspectives. We conclude there is a benefit to primary care physicians performing these procedures with regards to cost, access, and patient satisfaction with no compromise to outcomes, safety, and complication rates.
大关节和滑囊的类固醇注射及穿刺抽吸术对基层医疗中常见的许多肌肉骨骼疾病很有用。然而，对于基层医疗医生是应自行实施这些操作还是转诊给专科医生，目前尚不清楚。本研究回顾现有文献，以探讨基层医疗医生实施这些操作的影响。我们使用两种检索方案在PubMed上进行检索，以识别相关文章。两名研究者通过特定的纳入和排除标准独立筛选文章的相关性。另外两名研究者解决分歧。我们还手动检索了所有文章中的参考文献。检索方法共识别出257篇文章，其中132篇符合纳入标准。方案1结果的一致性几乎完美（kappa = 0.96，95% CI 0.91 - 0.99），方案2的一致性较高（kappa = 0.77，95% CI 0.60 - 0.94）。结果揭示了关于基层医疗医生进行大关节和滑囊类固醇注射及穿刺抽吸术的数据，包括当前趋势、管理和操作技术、结果、安全性和并发症发生率、患者获得治疗的情况、基层医疗与专科实施操作之间的成本差异、可行性问题、培训以及患者的观点。我们得出结论，基层医疗医生实施这些操作在成本、可及性和患者满意度方面有好处，且不会影响结果、安全性和并发症发生率。
