title: Benchmarking clinical management of spinal and non-spinal disorders using quality of life: results from the EPI3-LASER survey in primary care.
abstract: Concerns have been raised regarding sub-optimal utilization of analgesics and psychotropic drugs in the treatment of patients with chronic musculoskeletal disorders (MSDs) and their associated co-morbidities. The objective of this study was to describe drug prescriptions for the management of spinal and non-spinal MSDs contrasted against a standardized measure of quality of life. A representative population sample of 1,756 MSDs patients [38.5% with spinal disorder (SD) and 61.5% with non-spinal MSDs (NS-MSD)] was drawn from the EPI3-LASER survey of 825 general practitioners (GPs) in France. Physicians recorded their diagnoses and prescriptions on that day. Patients provided information on socio-demographics, lifestyle and quality of life using the Short Form 12 (SF-12) questionnaire. Chronicity of MSDs was defined as more than 12 weeks duration of the current episode. Chronic SD and NS-MSD patients were prescribed less analgesics and non-steroidal anti-inflammatory drugs than their non-chronic counterpart [odds ratios (OR) and 95% confidence intervals (CI), respectively: 0.4, 0.2-0.7 and 0.5, 0.3-0.6]. They also had more anxio-depressive co-morbidities reported by their physicians (SD: 16.1 vs.7.4%; NS-MSD: 21.6 vs. 9.5%) who prescribed more antidepressants and anxiolytics with a difference that was statistically significant only for spinal disorder patients (OR, 95% CI: 2.0, 1.1-3.6). Psychotropic drugs were more often prescribed in patients in the lower quartile of SF-12 mental score and prescriptions of analgesics in the lower quartile of SF-12 physical score (P < 0.001). In conclusion, anxiety and depressive disorders were commonly reported by GPs among chronic MSD patients. Their prescriptions of psychotropic and analgesic drugs were consistent with patients' self-rated mental and physical health.
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 4820 Boulevard Saint-Laurent, Montreal, QC H2T 1R5, Canada. Michel.Rossignol@CRR-Intl.com
authors.forename: Michel
authors.initials: M
authors.lastname: Rossignol
authors.forename: Bernard
authors.initials: B
authors.lastname: Begaud
authors.forename: Bernard
authors.initials: B
authors.lastname: Avouac
authors.forename: France
authors.initials: F
authors.lastname: Lert
authors.forename: Frederic
authors.initials: F
authors.lastname: Rouillon
authors.forename: Jacques
authors.initials: J
authors.lastname: Bénichou
authors.forename: Jacques
authors.initials: J
authors.lastname: Massol
authors.forename: Gerard
authors.initials: G
authors.lastname: Duru
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Magnier
authors.forename: Didier
authors.initials: D
authors.lastname: Guillemot
authors.forename: Lamiae
authors.initials: L
authors.lastname: Grimaldi-Bensouda
authors.forename: Lucien
authors.initials: L
authors.lastname: Abenhaim
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D019985:Benchmarking; D011307:Drug Prescriptions; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000592:standards*; D011788:Quality of Life; D013122:Spinal Diseases / Q000188:drug therapy / Q000628:therapy*; D011795:Surveys and Questionnaires
chemical_list: D000700:Analgesics