Communication and exchange of clinical findings for low back pain between general practitioners and orthopaedic surgeons: a retrospective observational study

• Published in: Schmerz (Berlin, Germany) Germany), 2009-04, Vol.23 (2), p.173-179
• Main Authors: Chenot, J-F, Pieper, A, Kochen, M M, Himmel, W
• Format: Article
• Language: ger
• Subjects: Ambulatory Care; Attitude of Health Personnel; Cooperative Behavior; Disease Progression; Family Practice; Female; Germany; Guideline Adherence; Humans; Interdisciplinary Communication; Low Back Pain - etiology; Low Back Pain - rehabilitation; Male; Middle Aged; Orthopedics; Referral and Consultation; Retrospective Studies
• ISSN: 1432-2129
• DOI: 10.1007/s00482-009-0776-7

Low back pain is a frequent reason for consultation in general practice. Many patients are treated in cooperation with an orthopaedic surgeon which requires an effective exchange of information. The aim of this study was to investigate the level of communication between general practitioners (GPs) and orthopaedic surgeons. In this retrospective observational study referrals from GPs and corresponding response letters from orthopaedic surgeons were analyzed. GPs were asked to provide reasons for referral and to rate the quality of the response letters. A total of 12 out of 82 GPs from the teaching network of the Medical School of Göttingen participated in the study. Of 911 referrals to ambulatory orthopaedic surgeons within 3 months, 34% (n=312) were referred for low back pain. GPs provided little information beyond a diagnosis on the referral contrary to their self-perception. Most referrals (61%) were initiated by patients and most of them were considered at risk for chronification (72%) by the referring GP. Despite a formal obligation to report back, GPs received a response letter for only one-third (114/312) of the patients. GPs rated most of them as satisfactory, however, 59% were unsatisfied with the treatment recommendations. Only 10% of the letters contained psychosocial details. The information provided in the orthopaedic response letters was heterogeneous and only partly fulfilled the criteria set by the Interdisciplinary Society for Orthopaedic Pain Management. Incomplete and scant information on referral forms from GPs and a high non-response rate from orthopaedic surgeons suggest that current health care system and referral forms do not promote effective communication about the patient. This might explain the satisfaction of GPs with the orthopaedic response letters despite the lack of information. The GPs dissatisfaction with the treatment recommendations reflects the limited treatment options for chronic low back pain in ambulatory care.