Information support of evidence-based managing of patients with musculoskeletal disorders in primary health care
Keywords:musculoskeletal disorders, primary care, evidence-based medicine, computer databases, Cochrane reviews, clinical recommendations and protocols
Health care efficacy depends on its resource support quality and adherence to the evidence-based approach. The study aimed to characterize the information support of evidence-based managing of patients with musculoskeletal disorders at the level of primary care. Materials and methods. Using information analysis, expert assessments and statistical methods, in the period of 2009–2019 we have been studying evidence-based medicine computer meta-databases, guidelines of both US Preventive Services Task Force (USPSTF) and Canadian Task Force of Preventive Health Care (CTFPHC), medical-and-technological documents of the Ministry of Health of Ukraine. Results. We have demonstrated intensive development of the Cochrane reviews on musculoskeletal disorders (up to 16 per year), their high rating (from 20 to 33.3 % among the top-ranking ones on the Cochrane Collaboration website, mostly concerning neuropathic pain and fibromyalgia), search option efficiency for a total of 785 reviews from this source and in the Cochrane Library on 40 topics from the categories “Rheumatology” and “Orthopaedics & Trauma”, of which 27.0 % are in Russian. The TRIP databases consistent advantages are identified, among them access to the latest evidence and their advanced search; it contains 130 documents on primary care, of which 4 (3.1 %) on musculoskeletal pain. EvidenceAlerts has even more evidence on the primary care — 13,259 documents, of which 140 (1.1 %) on the musculoskeletal system. The principal subject of both USPSTF and CTFPHC is fracture prevention in adults, as supported by their guidelines on screening for osteoporosis, recommendations on falls, taking vitamin D and calcium. Musculoskeletal disorders were focus of 6 out of 93 (6.5 %) guidelines and 3 out of 123 (2.4 %) unified protocols approved by the Ministry of Health of Ukraine during 2012–2017, and 165 out of 962 (17.2 %) new protocols, of which 98.8 % of which have chaptered entitled “Traumatology”, “Orthopaedics” and “Rheumatology”. Their share exceeds the musculoskeletal disorders’ share in the structures of diseases prevalence for the general population of Ukraine (5.4 %) and for the people of the workingage (5.6 %). Conclusions. Musculoskeletal diseases, pain and fractures make up the key and most popular subjects of the Cochrane Collaboration, whose website along with the Cochrane Library, TRIP and EvidenceAlerts is a useful source primarily for scientists. For the primary care specialists of Ukraine, the information support on musculoskeletal disorders relies on single unified protocols and 165 new ones, that should be used in continuing medical education. The population health may be improved by developing an adult fracture prevention program, taking into account the Cochrane Library’s source and the USPSTF and CTFPHC guidelines as especially useful for health managers and scientists.
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