dc.contributor.author | Nikles, Jane | |
dc.contributor.author | Yelland, Michael | |
dc.contributor.author | Bayram, Clare | |
dc.contributor.author | Miller, Graeme | |
dc.contributor.author | Sterling, Michele | |
dc.date.accessioned | 2018-02-20T00:22:54Z | |
dc.date.available | 2018-02-20T00:22:54Z | |
dc.date.issued | 2017 | |
dc.identifier.issn | 1471-2474 | |
dc.identifier.doi | 10.1186/s12891-017-1899-0 | |
dc.identifier.uri | http://hdl.handle.net/10072/369845 | |
dc.description.abstract | Background: Whiplash Associated Disorders (WAD) are common and costly, and are usually managed initially by
general practitioners (GPs). How GPs manage WAD is largely unstudied, though there are clinical guidelines. Our
aim was to ascertain the rate of management (percentage of encounters) of WAD among patients attending
Australian general practice, and to review management of these problems, including imaging, medications and
other treatments.
Methods: We analysed data from 2013 to 2016 collected by different random samples of approximately 1000
general practitioners (GPs) per year. Each GP collected data about 100 consecutive consultations for BEACH (Bettering
the Evaluation and Care of Health), an Australian national study of general practice encounters.
Main outcome measures were: the proportion of encounters involving management of WAD; management including
imaging, medications and other treatments given; appropriateness of treatment assessed against published clinical
guidelines.
Results: Of 291,100 encounters from 2919 GP participants (a nationally representative sample), WAD were managed at
137 encounters by 124 GPs (0.047%). Management rates were 0.050% (females) and 0.043% (males). For 63 new cases
(46%), 19 imaging tests were ordered, most commonly neck/cervical spine x-ray (52.6% of tests for new cases), and neck/
cervical spine CT scan (31.6%). One or more medications were prescribed/supplied for 53.3% of WAD. NSAIDs (11.7 per
100 WAD problems) and compound analgesics containing paracetamol and opioids (10.2 per 100 WAD problems) were
the commonest medications used by GPs overall. Paracetamol alone was used in 8 per 100 WAD problems. The most
frequent clinical/procedural treatments for WAD were physical medicine/rehabilitation (16.1 per 100 WAD problems),
counselling (6.6), and general advice/education (5.8).
Conclusions: GPs refer about 30% of new cases for imaging (possibly overutilising imaging), and prescribe a range of
drugs, approximately 22% of which are outside clinical guidelines. These findings suggest a need for further education of
GPs, including indications for imaging after whiplash injury, identification of those more likely to develop chronic WAD,
and medication management guidelines. WAD carry a large personal and economic burden, so the impact of
improvements in GP management is potentially significant. | |
dc.description.peerreviewed | Yes | |
dc.language | English | |
dc.language.iso | eng | |
dc.publisher | BioMed Central Ltd. | |
dc.relation.ispartofpagefrom | 551-1 | |
dc.relation.ispartofpageto | 551-9 | |
dc.relation.ispartofjournal | BMC Musculoskeletal Disorders | |
dc.relation.ispartofvolume | 18 | |
dc.subject.fieldofresearch | Clinical sciences | |
dc.subject.fieldofresearch | Clinical sciences not elsewhere classified | |
dc.subject.fieldofresearchcode | 3202 | |
dc.subject.fieldofresearchcode | 320299 | |
dc.title | Management of Whiplash Associated Disorders in Australian general practice | |
dc.type | Journal article | |
dc.type.description | C1 - Articles | |
dc.type.code | C - Journal Articles | |
dcterms.license | http://creativecommons.org/licenses/by/4.0/ | |
dc.description.version | Version of Record (VoR) | |
gro.rights.copyright | © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. | |
gro.hasfulltext | Full Text | |
gro.griffith.author | Yelland, Michael | |
gro.griffith.author | Sterling, Michele | |