title: General practitioners knowledge and management of whiplash associated disorders and post-traumatic stress disorder: implications for patient care.
abstract: In Australia, general practitioners (GPs) see around two-thirds of people injured in road traffic crashes. Road traffic crash injuries are commonly associated with diverse physical and psychological symptoms that may be difficult to diagnose and manage. Clinical guidelines have been developed to assist in delivering quality, consistent care, however the extent to which GPs knowledge and practice in diagnosing and managing road traffic crash injuries concords with the guidelines is unknown. This study aimed to explore Australian GPs knowledge, attitudes and practices regarding the diagnosis and management of road traffic crash injuries, specifically whiplash associated disorders (WAD) and post-traumatic stress disorder (PTSD).
  
  
  
  A cross-sectional survey of 423 GPs across Australia conducted between July and December 2014. We developed a questionnaire to assess their knowledge of WAD and PTSD, confidence in diagnosing and managing WAD and PTSD, frequency of referral to health providers, barriers to referral, and attitudes towards further education and training. Factor analysis, Spearman's correlation, and multiple ordered logistic regressions were performed.
  
  
  
  Overall, GPs have good level knowledge of WAD and PTSD; only 9.6 % (95 % CI: 7.1 %, 12.8 %) and 23.9 % (95 % CI: 20.8 %, 28.2 %) of them were deemed to have lower level knowledge of WAD and PTSD respectively. Key knowledge gaps included imaging indicators for WAD and indicators for psychological referral for PTSD. GPs who were male, with more years of experience, working in the urban area and with higher knowledge level of WAD were more confident in diagnosing and managing WAD. Only GPs PTSD knowledge level predicted confidence in diagnosing and managing PTSD. GPs most commonly referred to physiotherapists and least commonly to vocational rehabilitation providers. Barriers to referral included out-of-pocket costs incurred by patients and long waiting times. Most GPs felt positive towards further education on road traffic crash injury management.
  
  
  
  This study has enhanced understanding of the knowledge skills and attitudes of GPs towards road traffic crash injury care in Australia, and has identified areas for further education and training. If delivered, this training has the potential to reduce unnecessary imaging for WAD and optimise the early referral of patients at risk of delayed recovery following a road traffic crash.
authors.affiliation: Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia. bianca.brijnath@curtin.edu.au.|School of Occupational Therapy and Social Work, Curtin University, Perth, WA, 6152, Australia. bianca.brijnath@curtin.edu.au.
authors.forename: Bianca
authors.identifier: 0000-0002-0536-6859
authors.initials: B
authors.lastname: Brijnath
authors.affiliation: Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, Australia.
authors.forename: Samantha
authors.initials: S
authors.lastname: Bunzli
authors.affiliation: Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia.
authors.forename: Ting
authors.initials: T
authors.lastname: Xia
authors.affiliation: Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia.
authors.forename: Nabita
authors.initials: N
authors.lastname: Singh
authors.affiliation: Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Schattner
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia.|Institute for Safety Compensation and Recovery Research, Monash University, Melbourne, Australia.
authors.forename: Alex
authors.initials: A
authors.lastname: Collie
authors.affiliation: Recover Injury Research Centre, NHMRC CRE in Road Traffic Injury Recovery, Menzies Health Institute, Griffith University, Gold Coast, Australia.
authors.forename: Michele
authors.initials: M
authors.lastname: Sterling
authors.affiliation: Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia.
authors.forename: Danielle
authors.initials: D
authors.lastname: Mazza
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D001291:Attitude of Health Personnel; D001315:Australia; D002947:Cities; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D004502:Education, Medical, Continuing; D005260:Female; D058006:General Practice / Q000193:education; D006801:Humans; D008297:Male; D008875:Middle Aged; D011365:Professional Practice Location; D012017:Referral and Consultation / Q000706:statistics & numerical data; D020377:Self Efficacy; D012737:Sex Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000628:therapy*; D011795:Surveys and Questionnaires; D014911:Whiplash Injuries / Q000175:diagnosis* / Q000628:therapy*
keywords: Australia; General practice; Post-Traumatic Stress Disorder; Road traffic crash; Survey; Whiplash