title: Community-based orthopaedic follow-up. Is it what doctors and patients want?
abstract: BACKGROUND
  The objective of this study was to investigate how patients, general practitioners (GPs) and orthopaedic trainees, feel about the proposed governmental changes to reduce orthopaedic out-patient clinics by having GPs and specialist nurses follow-up postoperative orthopaedic patients in the community.
  
  
  METHODS
  The design was a cross-sectional questionnaire study including a teaching hospital and general practitioners in the Norfolk primary care trust. Participants were 73 orthopaedic postoperative patients who attended out-patients over a 1-week period in July 2007 who all responded. Of 250 GPs, 239 responded. Of 38 orthopaedic trainees at the level of senior house officer (post MRCS) and specialist registrar (Eastern Deanery Rotation and Pott Rotation), 30 responded
  
  
  RESULTS
  Of the 73 patients, 56 (77%) felt the surgeon was best suited to manage them postoperatively. Of these, 47 felt that it was very important that the surgical team saw them postoperatively. Also, 53 felt that their GP did not have sufficient knowledge and experience to deal with their current orthopaedic problem adequately. Only 12 GPs of 239 (5%) felt very confident assessing postoperative patients. Inadequate resources available to diagnose and treat postoperative complications was noted by 74% as the reason for not performing follow-up in primary care, and only 18% felt they should follow-up postoperative patients. All trainees felt that following up their own postoperative patients was important to their training.
  
  
  CONCLUSIONS
  Most patients, GPs, and orthopaedic trainees had serious doubts about the proposed governmental changes to reduce orthopaedic out-patient clinics by having GPs and specialist nurses follow-up postoperative orthopaedic patients in the community.
authors.affiliation: Institute of Orthopaedics, Norfolk and Norwich University Hospital, Norwich, UK. d.harle@uea.ac.uk
authors.forename: Daniel
authors.initials: D
authors.lastname: Harle
authors.forename: Shazad
authors.initials: S
authors.lastname: Ilyas
authors.forename: Clare
authors.initials: C
authors.lastname: Darrah
authors.forename: Keith
authors.initials: K
authors.lastname: Tucker
authors.forename: Simon
authors.initials: S
authors.lastname: Donell
mesh_terms: D001291:Attitude of Health Personnel; D003152:Community Health Nursing / Q000458:organization & administration; D003153:Community Health Services / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D004739:England; D005194:Family Practice / Q000458:organization & administration; D006801:Humans; D008505:Medical Staff, Hospital / Q000523:psychology; D019637:Orthopedic Procedures / Q000523:psychology* / Q000534:rehabilitation; D009985:Orthopedics / Q000458:organization & administration; D017060:Patient Satisfaction; D010821:Physicians, Family / Q000523:psychology; D011182:Postoperative Care; D011795:Surveys and Questionnaires