Management of Whiplash Associated Disorders in Australian general practice

Abstract

BackgroundWhiplash Associated Disorders (WAD) are common and costly, and are usually managed initially by general practitioners (GPs). How GPs manage WAD is largely unstudied, though there are clinical guidelines. Our aim was to ascertain the rate of management (percentage of encounters) of WAD among patients attending Australian general practice, and to review management of these problems, including imaging, medications and other treatments.MethodsWe analysed data from 2013 to 2016 collected by different random samples of approximately 1000 general practitioners (GPs) per year. Each GP collected data about 100 consecutive consultations for BEACH (Bettering the Evaluation and Care of Health), an Australian national study of general practice encounters.Main outcome measures were: the proportion of encounters involving management of WAD; management including imaging, medications and other treatments given; appropriateness of treatment assessed against published clinical guidelines.ResultsOf 291,100 encounters from 2919 GP participants (a nationally representative sample), WAD were managed at 137 encounters by 124 GPs (0.047%). Management rates were 0.050% (females) and 0.043% (males). For 63 new cases (46%), 19 imaging tests were ordered, most commonly neck/cervical spine x-ray (52.6% of tests for new cases), and neck/cervical spine CT scan (31.6%). One or more medications were prescribed/supplied for 53.3% of WAD. NSAIDs (11.7 per 100 WAD problems) and compound analgesics containing paracetamol and opioids (10.2 per 100 WAD problems) were the commonest medications used by GPs overall. Paracetamol alone was used in 8 per 100 WAD problems. The most frequent clinical/procedural treatments for WAD were physical medicine/rehabilitation (16.1 per 100 WAD problems), counselling (6.6), and general advice/education (5.8).ConclusionsGPs refer about 30% of new cases for imaging (possibly overutilising imaging), and prescribe a range of drugs, approximately 22% of which are outside clinical guidelines. These findings suggest a need for further education of GPs, including indications for imaging after whiplash injury, identification of those more likely to develop chronic WAD, and medication management guidelines. WAD carry a large personal and economic burden, so the impact of improvements in GP management is potentially significant.

Medical and allied health service use during acute and chronic post-injury periods in whiplash injured individuals

“…In Australia, most primary medical care is provided by GPs, the most common medical service provider consulted by individuals with WAD [17,38]. However, in the present study, slightly more claimants consulted with medical specialists than with GPs during an acute postinjury period.…”

“…Survey results showed that over one-half of emergency and primary health medical practitioners indicated that they would refer patients with WAD to physiotherapists [15,16], orthopaedic specialists [16], and psychologists [16]. However, audits of general practitioner (GP) management of individuals with WAD in Australia [17] and insurance claimant data in Canada [12] found that less than onequarter of individuals were referred to physiotherapists and medical specialists. There appears to be no data available about referral of individuals with WAD to psychologists.…”

An Interactive Website for Whiplash Management (My Whiplash Navigator): Process Evaluation of Design and Implementation

“…Whiplash-associated disorders (WAD) remain a huge health and economic burden internationally [1-3], with 50% of people experiencing persistent pain and disability [4-6]. One possible contributor to this burden is that WAD guidelines are inconsistently applied by health care professionals (HCPs) [7,8]. Inconsistent and costly practices include high rates of imaging, excessive use of passive treatments, and delayed and poorly directed specialist referral [8-13].…”

Effect of intensive inpatient physical therapy on whole-body indefinite symptoms in patients with whiplash-associated disorders

“…A review reports that some active treatments, although not specified, have a tendency to be more effective than only resting of the neck [11]. Several reports have shown that pharmacological interventions such as paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids have slight or moderate effects [12, 13]. However, these studies are limited to the management of local pain in the neck or shoulder, performed as outpatient care for acute WAD.…”