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Factors associated with physiotherapy prescription among adult patients consulting for musculoskeletal disorders in primary care

Abstract : Learning objectives - On completion of this session, participants should be able to identify factors associated with physiotherapy prescription for patients consulting for musculoskeletal disorder (MSD) in primary care. - On completion of this session, participants should be aware to the interest of using a multilevel approach in primary care epidemiology. Context MSDs are a frequent reason for encounter in general practitioners (GPs) consultations. Their management is based on a bio-psycho-social approach, including sometimes physiotherapy prescription (PP). Physiotherapy is mainly initiated by GPs but little is known about the factors associated with PP during consultations related to MSDs. Objective To evaluate the factors associated with general practitioners’ physiotherapy prescription among adult patients consulting for musculoskeletal disorders (MSDs). Human subjects review The ECOGEN study was approved by ethical comity (CPP Sud-Est IV L11-149, 10/11/2011). Design this study is based on the French observational cross-sectional ECOGEN study carried out in 2011/2012 among 128 GPs. Setting Patients and physicians characteristics, consultation results and healthcare procedures were systematically collected using International Classification of Primary Care (ICPC-2). Analyses focused on patients aged between 18 and 65 years-old consulting their GP for any MSD in primary care. Main and secondary outcome measures Prevalence of PP was first assessed, then the factors associated with PP were explored using an adjusted multilevel (patient / physician / geographical area) logistic model. Hierarchical ascending classification (HAC) was used to identify patient profiles. Anticipated results Among the 2305 patients included, 456 (19.8%) were prescribed physiotherapy. Following multivariate multilevel analyses, PP was more frequent for female patients (OR 1.28; 1.03-1.59) and among patients with spinal (OR 1.47; 1.18-1.83) and cuff rotator tendinitis-related (OR 1.66; 1.20-2.29) disorders. PP was less frequent for patients older than 50 years-old (OR 0.69; 0.52-0.91) having more than 3 healthcare procedures prescribed during the consultation, when GPs were older than 50 years-old (OR 0.50; 0.39-0.63), had a high activity level (OR 0.79; 0.63-0.99), practice in semi-urban area (OR 0.62; 0.42-0.90) in multidisciplinary team (OR 0.62; 0.43-0.90) and when patients lived in precarious geographical area (OR 0.60; 0.40-0.90). Seven clinically sound patient clusters were identified by HAC. Conclusion This multilevel analysis show differences in rate of physiotherapy prescription for MSD patients consulting for MSD, particularly physician’s related factors and potential territorial disparities, which should be considered in a health inequalities reduction approach.
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https://hal.univ-angers.fr/hal-02480823
Contributeur : Natacha Fouquet <>
Soumis le : lundi 17 février 2020 - 09:27:51
Dernière modification le : mercredi 14 octobre 2020 - 04:16:44
Archivage à long terme le : : lundi 18 mai 2020 - 13:58:59

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  • HAL Id : hal-02480823, version 1

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Matthieu Peurois, Aline Ramond-Roquin, Najia Adjeroud, Mélanie Bertin, Natacha Fouquet, et al.. Factors associated with physiotherapy prescription among adult patients consulting for musculoskeletal disorders in primary care. 47th North American Primary Care Research Group (NAPCRG) annual meeting, Nov 2019, Toronto, Canada. ⟨hal-02480823⟩

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