Minor surgery in general practice in Ireland- a report of workload and safety

Joint and soft tissue injections in Irish primary care: a survey of GPs' attitudes and practices

BACKGROUND

Musculoskeletal conditions are common in primary care, causing significant morbidity. Intra-articular and soft tissue corticosteroid injections are commonly performed by GPs internationally. It is unknown how commonly they are performed by GPs in the Republic of Ireland.

AIM

To determine the frequency and type of joint and soft tissue injections performed by GPs in the Republic of Ireland and investigate factors affecting their use.

DESIGN & SETTING

A cross-sectional online questionnaire, which was based on previous international research, was devised for completion by GPs practising in the Republic of Ireland.

METHOD

GPs were invited to electronically complete a questionnaire on their practices and attitudes regarding joint and soft tissue injections.

RESULTS

A total of 147 of 204 GPs (72.1%) had performed an intra-articular or soft tissue injection in the preceding year. GPs who were principals or partners, male, or worked in a rural or mixed urban and rural practice setting were more likely to perform these procedures. The most common injection sites were the shoulder and knee. Participants were confident about performing joint and soft tissue injections. It was found that 80.4% had received prior training in this treatment modality, most commonly during their GP training programme. A prolonged wait for secondary care intervention, symptom duration, and symptom severity were factors that increased the likelihood of performing injections. Difficulty maintaining skills and medicolegal concerns were common barriers to performing joint and soft tissue injections.

CONCLUSION

Most GPs surveyed carried out joint and soft tissue injections, most commonly injecting the shoulder and knee. Irish GPs experience many of the same barriers to performing intra-articular injection as experienced internationally.

Minor surgery in primary care has reduced minor surgery waiting lists: a 12-month review

BACKGROUND

To investigate minor procedures performed in general practice, to alleviate the burden on the economy, patients and secondary care physicians.

AIMS

To determine the range of minor surgical procedures performed in a single group general practice, subsequent referrals made to secondary care, follow-up surgical procedures required and post-operative complications within a patient group.

METHODS

Retrospective data collection from the electronic records of a single group general practice consisting of 5101 active patients within the previous 12 months. Through use of Socrates software program and statistical analysis, patients were stratified into demographics, including, age, gender, the cost of the procedure, the type of procedure being carried out, the post-operative referral rate to secondary care and any subsequent procedures required. The patients were excluded if their minor procedure was classified as a joint injection.

RESULTS

133 procedures were carried out over the 12-month period. Of these patients, the majority were male, and the mean age was 44 years old. The most common procedures included the removal of ingrown toenails, lesion excisions and punch biopsies. Histological analysis was done on biopsies, with a low rate of misdiagnosis pre-operatively. Additionally, there were minimal referrals and no complications recorded.

CONCLUSIONS

This study has demonstrated the ability for minor surgery to be safely carried out in primary care. The integration of general practice, general surgery and plastic surgery could provide a higher level of patient care and exchange of skills to help reduce waiting lists and alleviate the burden secondary care.

Office-Based Minor Surgery: An Ever-Increasing Challenge Not Only for the Dutch General Practitioner

BACKGROUND AND OBJECTIVES

Office-based minor surgery (OBMS) refers to all surgical procedures performed under local anesthetic in the office setting. It is cost effective for the health economy, safe, and appreciated by patients. It is not yet fully understood why some general practitioners (GPs) perform OBMS and others do not, while there is a growing demand for OBMS. Therefore, we explored factors that influence the performance of OBMS by GPs. The aim of this study is to explore the facilitators and barriers that influence GPs in deciding whether to perform OBMS.

METHODS

We performed a qualitative study using focus groups consisting of GPs and GP trainers. Two researchers analyzed the data independently.

RESULTS

The analysis resulted in a comprehensive list of facilitators and barriers. Besides already known factors such as financial consequences and geographic location, the most important factors influencing the decision to perform OBMS were training and the role of the GP trainer; fear of having to work alone and having to solve unexpected complications; and the influence of collaboration, organization, and facilities in the GP's own practice.

CONCLUSIONS

The increasing demand for OBMS in primary care centers requires more attention to training aspects, the existing fear, adequate reimbursement for special accreditation, and collaboration and organization. We expect that addressing these factors will result in the strengthening of primary care, improving patient safety, lower referral rates, and a reduction in health care costs.