What post-op info does the GP need from the Orthopaedic Surgeon? Patrik Vankrunkelsven ACHG Academisch centrum Huisartsgeneeskunde ACHG Academisch centrum Huisartsgeneeskunde CEBAMBelgian Centre for Evidence Based Medicine ACHG Academisch centrum Huisartsgeneeskunde CEBAMBelgian Centre for Evidence Based Medicine G&WGezondheid en Wetenschap CEBAMBelgian Centre for Evidence Based Medicine G&WGezondheid en Wetenschap 1
1980: 7 years 2010: 3,5 years 2010: 3,5 years 1980: 7 years 1980: 7 years By 2020: 73 days More needforsr More need for real evidence More need for guidelines CEBAMBelgian Centre for Evidence Based Medicine 2
Knee osteoarthritis Survey in GPs Patients Health Records 10 % physiotherapy 25 % arthroscopy Knee osteoarthritis CEBAMBelgian Centre for Evidence Based Medicine Survey in GPs Patients Health Records 10 % physiotherapy 25 % arthroscopy = opposite of the guidelines Promotes EBM via Education Digital library CDLH 5 top journals on orthopaedics+ Dynamedplus( Up to date) 100 a year S CEBAMBelgian Centre for Evidence Based Medicine Promotes EBM via Education Digital library CDLH 5 top journals on orthopaedics + Dynamed plus ( Up to date) 100 a year S G&WGezondheid en Wetenschap Promotes EBM for patients 800 guidelines for patients Every day critical assessment of medical news in the media 3
What post-op info does the GP need from the Orthopaedic Surgeon? 20 Introduction In preparation of this congress we asked 25 GP s some questions on orthopedic surgery More specifically we asked about: o the (dis)advantages of early hospital discharge o the learning points for themselves and for surgeons 1. Are you (as GP) familiar with following procedures? This presentation has no pretention to be complete, but it s exemplary for the feelings of GPs 21 22 You are familiar with... You are familiar with... To do and assess preop. examination To do and assess preop. examination To administer postop. pain medication Postoperative wound care Postoperative anticoagulation FU of the patient with orthopedic trauma Prescript and FU physioth./exercise advice Follow-up of orthopedic oncology pt To administer postop. pain medication Postoperative wound care Postoperative anticoagulation FU of the patient with orthopedic trauma Prescript and FU physioth./exercise advice Follow-up of orthopedic oncology pt 0 10 20 30 40 50 60 70 80 90 100 Depends on pathology (%) rather not familiar (%) rather familiar (%) 0 10 20 30 40 50 60 70 80 90 100 Depends on pathology (%) rather not familiar (%) rather familiar (%) 23 24 4
Wich orthopedic pathology you feel sufficiently confident with? 2. With some discharged patients we feel more confident than with others knee hip shoulder hand/ellbow trauma foot back onco - 0 10 20 30 40 50 60 70 80 90 25 26 Wich orthopedic pathology you feel sufficiently confident with? 3. Advantages of early hospital discharge knee hip shoulder hand/ellbow trauma foot back a. Reduced hospital infections b. Less hospital psychoses c. Patient in his own environment (more pleasant, better sleep, food,...) d. Benefits for rehabilitation ( to get on his legs again ) e. Economic benefits for society and patient onco - 0 10 20 30 40 50 60 70 80 90 27 28 4. Disadvantages of early hospital discharge a. No high technologic (hospital) service b. Less intense rehabilitation (follow-up, equipment,...) c. For solitary persons informal care by relatives is not always (quickly) operational d. Complications (eg bleeding) later discovered, more difficult to treat e. No IV catheter (eg pain medications) f. More surinfections (??) g. Difficulties in complex wound care, eg drains h. First line sometimes does not have sufficient knowledge of certain issues 29 30 5
patient (LMWH / pt on NOAC, coumarine) patient c. More generally, GPs should have more knowledge of alarm signs 31 32 patient c. More generally, GPs should have more knowledge of alarm signs d. Good communication with orthopedic surgeon!! Good accessibility of the service involved. Would like to have one telephone number where the physician involved, at least assistant, can be reached quickly for information and consultation patient c. More generally, GPs should have more knowledge of alarm signs d. Good communication with orthopedic surgeon!! Good accessibility of the service involved. Would like to have one telephone number where the physician involved, at least assistant, can be reached quickly for information and consultation e. Development of clear protocols containing task agreements for different care providers 33 34 One word communication 35 36 6
Thanks! 37 7