Minor surgical procedures and musculoskeletal injections by primary care physicians - an Israeli experience

Abstract

AbstarctBackgroundSince minor surgical and musculoskeletal problems are commonly seen in primary care, primary care physicians are expected to possess the skills required to perform minor surgical procedures (MSP) and musculoskeletal injections (MSI).ObjectiveTo evaluate the performance of MSP and MSI by primary care physicians in the Southern District (Negev) of Clalit Health Services (CHS) health maintenance organization (HMO) in Israel.MethodsA structured self-report questionnaire was sent to all 277 primary care physicians, other than pediatricians, working in the Southern District (Negev) of CHS HMO.ResultsOne hundred fifty one of the 277 questionnaires (54%) were completed and returned. Sixty five percent of the primary care physicians perform any MSP and 46% perform any MSI. The main barriers reported for performing MSP and MSI were lack of time (74% and 66%, respectively) and training (41% and 60%, respectively). Forty percent of the physicians cited remuneration as a potential motivating factor. A logistic regression model showed that male physicians and physicians who work full or part-time in rural areas, are more likely to perform MSP (Odds ratio 2.12 and 2.24, respectively). Male physicians, especially board-certified family physicians, are more likely to perform MSI (Odds ratio 2.86 and 7.0 respectively).ConclusionMSP and MSI are practiced by only some primary care physicians. HMOs and individuals responsible for designing training curricula in family medicine and primary care can encourage primary care physicians to perform MSP and MSI by providing courses, specific compensation, and dedicated time. This can strengthen the bond between primary care physicians and patients, reduce waiting time for patients, and save money for HMO’s.

Referral patterns of Israeli pediatricians of common primary care office procedures

“…It has also been shown to provide physicians with professional satisfaction [ 12 ]. Nevertheless, studies among family practice physicians have shown that often this performance does not take place [ 13 – 15 ].…”

“…A study of joint injections in Saudi Arabia found less than 10 % performance of almost all treatment [ 14 ]. In southern Israel, Menahem et al found that 65 % of the primary care physicians perform any minor surgical procedures and 46 % perform any muscular injections [ 15 ]. In all of the studies, a repeated thread in reasons for not performing the procedures was lack of up to date skills and lack of time.…”

Teaching Minor Surgical Procedures in Internship in Primary Care: A Necessary Approach

“…Skin and subcutaneous lesions (nevus, fibromas, lipomas), lacerations, ingrown toenails, abscesses, musculoskeletal disorders such as arthritis, bursitis, trigger points, neuropathies and tendinitis are the main causes of problems in primary care that can be resolved with minor procedures (Menahem, Nazarenko & Shvartzman, 2014). Performing these procedures is an important part of the general practitioner's competencies (Nasmith & Franco, 1997).…”

“…In addition to the financial benefits, performing small procedures in primary care reduces patient anxiety, as the procedure is performed by the family doctor and not by an unknown doctor, has greater convenience due to the proximity and familiarity with the health unit, lower waiting time for treatment and financial savings, since procedures performed in primary care clinics are cheaper than hospital ones (Menahem, Nazarenko and Shvartzman, 2014).…”

“…However, there are still few health facilities that perform these procedures. Lack of time and training were the main reported barriers to their achievement (Menahem, Nazarenko and Shvartzman, 2014). Thus, continuing education must be present in primary care, so that professionals can improve their skills.…”