PATIENTS’ PERCEPTIONS OF QUALITY OF PRIMARY CARE FOR MONO-TRAUMA TO AN EXTREMITY

Abstract

Hypothesis: Patients with mono-trauma to an extremity often consult primary care prior to being referred to orthopedics services. Appropriate pain control, immobilization and walking aids are not always given to ambulatory patients.

Methods: The study used a prospective trauma database of all new ambulatory cases with an isolated injury to an extremity referred to an orthopedic trauma clinic at a level-one trauma center. Patients arriving by ambulance and those that were not able to filled questionnaires were excluded. Data were collected at the initial visit regarding the type of trauma, the medical consultations prior to orthopedic evaluation, the initial management (cast, walking aids, pain control), patient’s socio-demographic characteristics, and patient satisfaction (Visit-Specific Satisfaction Questionnaire: VSQ).

Results: Our sample consisted of 166 consecutives patients referred for fracture (85%) and soft tissue injury(15%) to an orthopedic trauma clinic. Nearly two-thirds (65%) had upper limb injuries. 47% of patients were referred from the same hospital emergency, while 53% were referred from other hospitals or clinics. In terms of patient perceptions, 50% considered their injury as a serious health problem. The average satisfaction score (VSQ) was 84%. However, 50% of patients had a substantial degree of pain (> 5/10) at the time of orthopaedic consultation. In addition, 30% of patients received no prescription for analgesics and declared that they missed it and 21% who received a prescription claimed it was not sufficient to decrease their pain. Of those who required immobilization following the type of injury, 30% received none or it was unsuitable. 1/6 of patients who required crutches/cane/wheelchair for a lower limb injury had none prescribed.

Conclusion: Primary care for persons with mono-trauma was suboptimal in terms of pain control and immobilization for more then 40% of patients. General practitioners showed a lack of basic knowledge on the importance of initial treatment of isolated limb injury.

Significance: Isolated fractures are a common problem affecting a large amount of the population. This study identified unacceptable rate of poor initial management for simple injury. Orthopedic trauma surgeon must be informed of this reality and then, becoming more involved in primary care education in their own health care network.