Years in practice influences musculoskeletal pain management advice
medwireNews: Despite strong recommendations for advising exercise or physical activity for the management of musculoskeletal pain, physicians are still failing to do so, suggest findings from a factorial experiment.
The results also indicate that this failing may be more common among physicians with more experience.
“The possibility that newer physicians are more up to date on recommendations or guidelines from medical societies is consistent with prior studies,” notes the team, led by Nancy Maserejian (New England Research Institutes, Watertown, Massachusetts, USA).
The researchers assigned 192 primary care physicians to watch two videos in which actors depicted a patient presenting with undiagnosed sciatica symptoms and undiagnosed knee osteoarthritis (OA). The physicians were then interviewed about the clinical decisions they would make in line with current recommendations by the American College of Rheumatology and the American Pain Society.
Twenty-two percent of the physicians had been in practice for more than 30 years, whereas 20.8% had graduated within the past 10 years.
Newer physicians were significantly more likely than more experienced physicians to give recommended advice on lifestyle behaviors, particularly regarding exercise habits, at 39.6% versus 26.0% for the sciatica patient and 39.6% versus 20.8% for the knee OA patient. Similar differences were seen for advice to lose weight and referrals for physical therapy.
The researchers note in Arthritis Care and Research that the probability of giving recommended lifestyle advice increased linearly with the length of time in practice. And such advice was more likely to be given if physicians were in organizations that focused primarily on quality of care.
Analgesic prescribing and test ordering were also associated with physicians’ years of experience. Newer physicians more commonly prescribed nonsteroid anti-inflammatory drugs (NSAIDs) for pain relief and ordered slightly fewer tests, on average, than more experienced physicians, particularly if they were in practices that focused on business decisions and profit maximization.
The researchers report that 33.9% of physicians would have ordered magnetic resonance imaging for the sciatica patient and 13.5% for the OA patient, despite this contrasting with current evidence-based recommendations. For the OA patient only, this was most common among the 7.3% of physicians who said they did not generally use current guidelines.
Patient factors and physician gender did not appear to consistently influence the advice given by physicians.
Maserejian and co-workers say that “[m]ethods to more effectively disseminate current recommendations for diagnosis and management of pain conditions should be developed and tested to improve the quality of care for these common clinical problems.”
medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2014
By Lucy Piper, Senior medwireNews Reporter