The GRIP Study: General Practitioners Prevention and Management of Road Traffic Crash Injuries

Transcription

1 Medicine, Nursing and Health Sciences The GRIP Study: General Practitioners Prevention and Management of Road Traffic Crash Injuries Bianca Brijnath 1, Samantha Bunzli 1, Ting Xia 1, Nabita Singh 1, Alex Collie 2,3, Michele Sterling 4, Peter Schattner 1 and Danielle Mazza 1 1. Department of General Practice, Monash University 2. Institute for Safety Compensation and Recovery Research, Monash University 3. Department of Epidemiology and Preventive Medicine, Monash University 4. Centre of National Research on Disability and Rehabilitation, Menzies Health Institute Queensland, Griffith University Impact of road injury Physical Psychological Social Financial Role of GP Diagnosis Monitor medical complications Manage psychosocial yellow flags Deliver, coordinate intervention Assess, facilitate return to work 2 1

2 Current gap Substantive economic and social burdens road traffic injuries pose on Australian society GPs are critical players Little is known about: Current practice and; GP education and training needs Australian first study 3 Aims I. To determine at a national level the current knowledge, attitudes and practices of GPs in diagnosing and managing RTC injuries II. To identify education and training needs of GPs Australia wide to optimise diagnosis and management of RTC injuries. 4 2

3 Methods Design A national survey. Survey questions Literature GP-Return to Work Study Current guidelines Whiplash injury guidelines (Motor Accident Authority) Australian guidelines for the treatment of Acute Stress Disorder and PTSD (Australian Centre for Posttraumatic Mental Health) Expert consultation Pilot tested with 15 GPs Melbourne 5 Methods Demographic Knowledge Confidence Further training Presentation title 28th February

4 Methods Sample Australian Medical Publishing Company Database to randomly recruit 3000 GPs Recruitment July-Dec 2014 Mail out to 3000 GPs Follow-up mail out to 2000 GPs 2 weeks later Response rate 423 out of 3000 GPs responded (14%) Initial mail-out: 276/3000 (9%) Follow up: 147/2000 (7%) 7 Findings-Demographics Age 25-35yrs 36-45yrs 46-60yrs 60+yrs Gender Male Female Years of experience 5yrs 6-10yrs 11-15yrs 16-20yrs 20+yrs n (%) 50 (11.8) 96 (22.7) 168 (39.7) 109 (25.8) 214 (50.6) 209 (49.4) 62 (14.7) 40 (9.5) 50 (11.8) 45 (10.7) 225 (53.3) Location of practice Remote Regional Urban State where practice is based VIC NSW SA QLD NT WA TAS ACT 33 (7.8) 139 (32.9) 251 (59.3) 106 (25.1) 129 (30.5) 38 (9.0) 92 (21.7) 6 (1.4) 27 (6.4) 19 (4.5) 6 (1.4) 8 4

5 Approximately which of the following RTC injuries have you seen among your patients within the past three years (tick one or more choices): Responses for items dealing with knowledge about whiplash injury and PTSD Item T/F % correct Whiplash 1. People with a whiplash injury to the neck have a poorer prognosis when: a. Pain > 7/10 on a Visual Analogue Scale on day 1 vs follow up T 38 b. People have a psychological injury or psychological comorbidity T 95 c. People have a low expectation of recovery T 90 d. People do not have an expectation of return to work T Components of a whiplash injury that indicate the need for cervical spine X-ray include: a. Inability to rotate the neck beyond 45 degrees to the left or right T 44 b. Paraesthesia in the extremities T 95 c. Age to 65 years T

6 Item T/F % correct 3. Effective evidence-based treatments for whiplash disorder include: a. Range of movement exercises T 95 b. Manipulation F 20 c. Passive mobilisation F 73 d. Collars F 76 e. Rest in bed rather than graded return to usual activities F 96 Average Item T/F % correct 4. People who are likely to have a poorer prognosis from PTSD if untreated include: a. People who have PTSD symptoms persisting beyond one month after the injury T 85 b. People whose physical injuries are of greater severity F 34 c. People involved in litigation for criminal or civil purposes T I would usually refer a patient with a post-traumatic stress presentation to mental health services if there was: a. Prominence of depression in the presentation T 81 b. Prominence of pain in the presentation T 31 c. Presence of PTSD symptoms subsequent to a mild traumatic brain injury T 72 d. Presence of PTSD symptoms persisting beyond one month post injury T 82 e. Presence of a mental health history T

7 Item T/F % correct 6. First line evidence-based treatments for adults with PTSD include : a. Trauma focused cognitive behaviour therapy (CBT) T 89 b. Selective Serotonin Reuptake (SSRI) F 22 c. Whiplash: Benzodiazepines 16.7% poor, 59.4% moderate, 23.9% F high Aside from PTSD, psychiatric disorders that can commonly occur following a RTC injury PTSD: 9.5% poor, 58.2% moderate, 32.2% high include: a. Major Depressive Disorder T 83 b. Generalized Anxiety Disorder T 94 c. Brief Psychotic Disorder F 49 d. Substance Use Disorder T 59 Average GPs confidence in diagnosing and managing: Disagree Not sure Agree I am confident in my ability to diagnose whiplash injury I am confident in my ability to diagnose whiplash injury I am confident in my ability to diagnose PTSD I am confident in my ability to diagnose PTSD 14 7

8 Findings-Predictors of confidence Diagnosing whiplash Managing whiplash Diagnosing PTSD Managing PTSD OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) Gender Male 1 (ref) 1 (ref) 1 (ref) 1 (ref) Female 0.54 ( ) 0.72 ( ) 1.08 ( ) 0.99 ( ) Years of experience as a GP < or equal to 10 yrs 1 (ref) 1 (ref) 1 (ref) 1 (ref) yrs 2.19 ( ) 2.38 ( ) 1.17 ( ) 0.73 ( ) 20+ yrs 2.78 ( ) 2.26 ( ) 1.61 ( ) 1.04 ( ) Location of practice Remote 1 (ref) 1 (ref) 1 (ref) 1 (ref) Regional 1.90 ( ) 2.91 ( ) 0.66 ( ) 0.54 ( ) Urban 2.45 ( ) 2.03 ( ) 0.50 ( ) 0.53 ( ) Overall no. of GPs in practice 1 1 (ref) 1 (ref) 1 (ref) 1 (ref) ( ) 2.18 ( ) 0.96 ( ) 1.11 ( ) ( ) 1.38 ( ) 1.54 ( ) 0.94 ( ) > or equal to ( ) 1.28 ( ) 1.06 ( ) 1.00 ( ) Whiplash knowledge level Low 1 (ref) 1 (ref) Middle 2.38 ( ) 2.13 ( ) - - High 2.86 ( ) 2.93 ( ) PTSD knowledge level Low 1.85 ( )* 1.73 ( )* Middle ( )* 2.42 ( )* High 15 Further education and training Negative association with GPs confidence of diagnosing and managing whiplash Diagnosis and management of cervical whiplash injury following a road traffic crash The guidelines available for acute whiplash management Diagnosis and management of psychological conditions following a road traffic crash 16 8

9 Summary Key gaps in GP knowledge GPs were more confident in diagnosing and managing whiplash than PTSD GP s age, gender, years of experience and locality were predicted confidence in diagnosing whiplash 17 Next steps This study provides a baseline for GPs knowledge and attitudes of RTC injuries against which further studies can be compared. Provision of tailored education on RTC injuries particularly on PTSD diagnosis and management. Better GP diagnosis and management may enable RTC patients to make speedier recoveries and timelier, appropriate return to safe work. 18 9