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As in our study, procedures for primary care was no association between the number of procedures performed and the age of the participating physicians or their length of employment, but in contrast to our study there was no difference between urban and rural clinical settings.

Fifty percent of the physicians did not perform surgical procedures irrespective of whether they participated procedures for primary care the course [ 18 ], compared to one third in the present study.

Similarly, several surveys have addressed MSI performance by primary care physicians. A survey from the United Kingdom explored joint and soft tissue injections by general practitioners.

Factors associated with higher levels of injection activity were: The most important procedures for primary care to carrying out injections were lack of practical training, lack of confidence, and inability to maintain skills.

The most injected musculoskeletal problems were tennis elbow, knee joint and glenohumeral joint [ 25 ]. Five percent of the primary care physicians carried out most of the injections done in the community.

Services & Procedures

Injections into the shoulder, knee and lateral epicondyle were the most commonly performed. The barriers to performing injections included in descending order: In our survey lack of time was the main barrier.

In a randomized study from Northern Ireland of two different training programs for general practitioners in the techniques of shoulder injection, physicians that received training on real patients were significantly more confident in performing injections than physicians who were trained using mannequins [ procedures for primary care ].

Two more studies from the United Kingdom and the Netherlands showed that training programs for primary care physicians on shoulder injections techniques increase their performance rate [ 2829 ]. Another survey of primary care internists from the United States showed that a training program in outpatient primary care could increase MSI performance [ 30 ].

The conclusion was that many physicians working in primary care settings in Saudi Arabia refer patients who require musculoskeletal injections to specialists for consultation, even though treating these patients at the primary care level is more time- and cost effective procedures for primary care 31 ].

Interpretation of the study results in relation to existing literature In our survey, as well as those reported from other countries, MSP and MSI performance rates were higher in male physicians and those who work in rural areas.

Essential Procedures for Emergency, Urgent, and Primary Care Settings, Second Edition

The best performance improvement reported in the literature resulted from a course in which physicians practiced on actual patients. The physicians in the present study ranked setting aside dedicated procedure procedures for primary care and a training course as the most important facilitating factors, while they ranked live demonstrations on patients as third.


Strengths and limitations Our study has some limitations. Second, self-report is less accurate than actual measurement of performance and physicians may overestimate their performance.

Third, those who answered the questionnaire could be more interested in the subject and tend to perform procedures more than those who did not. Forth, the study was limited to the south of Israel and included physicians from only procedures for primary care HMO, albeit the largest in the region.

Primary Care Procedures - Table of Contents

Potential socio-demographic differences between all primary care physicians in the Southern District Negev CHS HMO and those who participated in the study could affect the results, since our study population consisted procedures for primary care a higher percentage of specialists in family medicine and graduates of Israeli medical schools compared to all primary care physicians in the south.

Thus, the performance rate for all primary care physicians might actually be lower than the observed rate in this study. Sending specimens to histopathological examination could be a barrier to MSP performance that was not addressed in the questionnaire.

However, the results of the present survey are similar to those of studies from other countries, a finding that strengthens the reliability of the results for our region. Health policy implications of the findings More than two thirds of the primary care physicians in the study stated that MSP and MSI should be an integral part of their job.


In actual practice, the overall performance rate was low. By providing courses for residents and post-graduates and providing appropriate compensation, time and equipment, the performance of MSP and MSI could be increased.

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This would save money for the HMOs, which function in a setting of an ongoing financial crisis in the healthcare system in Israel and in other countries where specialist fees are much higher than those of primary care physicians, even though they have longer procedures for primary care times.

Conclusion Although the procedures for primary care of primary care physicians state that MSP and MSI should be an integral part of their work and its performance is cost effective, it is practiced by primary care physicians at lower rates than expected. An emphasis should be placed on women and primary care physicians working in urban areas.