title: How do general practitioners manage hip problems in adults?
abstract: OBJECTIVE
  To investigate the medical management, and its consistency and determinants, of hip problems in adult patients.
  
  
  METHODS
  General practice, The Netherlands.
  
  
  METHODS
  Observational study based on four "paper patients" and on computerised patients records (CPRs) of 400 patients (20 per general practitioner), aged 50 years and over, with new hip problems.
  
  
  METHODS
  20 general practitioners.
  
  
  METHODS
  Examination, diagnosis and treatment of hip patients.
  
  
  RESULTS
  Medical history and physical examination consisted mainly of questions concerning pain localisation and onset, and examining passive hip motion. The paper patients, except for the one with alarming symptoms, and the CPRs showed high variation in management between general practitioners, particularly for medication prescription and X-ray requests. Main factors influencing medical management were patients' age, number of visits and attitude of the individual general practitioner. A specific diagnosis was registered for only 32% of the 400 patients. The diagnosis osteoarthritis varied greatly between general practitioners even after adjustment for patients' age, gender and number of visits. Patients with osteoarthritis were infrequently referred to physical therapy and received nonsteroidal anti-inflammatory drugs (NSAIDs) more often than paracetamol.
  
  
  CONCLUSIONS
  Diagnosis and treatment of hip problems varies widely between general practitioners. Treatment of patients with osteoarthritis is inconsistent with published recommendations.
authors.affiliation: Department of General Practice, Erasmus University, Rotterdam, The Netherlands.
authors.forename: S M
authors.initials: SM
authors.lastname: Bierma-Zeinstra
authors.forename: S
authors.initials: S
authors.lastname: Lipschart
authors.forename: K H
authors.initials: KH
authors.lastname: Njoo
authors.forename: R
authors.initials: R
authors.lastname: Bernsen
authors.forename: J
authors.initials: J
authors.lastname: Verhaar
authors.forename: A
authors.initials: A
authors.lastname: Prins
authors.forename: A M
authors.initials: AM
authors.lastname: Bohnen
mesh_terms: D000368:Aged; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006620:Hip Fractures / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D009426:Netherlands; D010003:Osteoarthritis / Q000175:diagnosis* / Q000628:therapy; D017410:Practice Guidelines as Topic