C W Zukowski | PubMed Health

PubMed1996

Patient profile, referral sources, and consultant utilization in a primary care sports medicine clinic.

BACKGROUND: Sports medicine has matured as a focused discipline within primary care with the number of primary care sports medicine physicians growing annually. The practices of these physicians range from "part-time" sports medicine as a part of a broader practice in their primary specialty, to functioning as a full-time team physician for a university or college. Managed care organizations are increasingly incorporating primary care sports medicine providers into their organizations. The optimal role of these providers in a managed care system has not been described. METHODS: A descriptive analysis was made of patient contacts in a referral-based, free-standing primary care sports medicine clinic associated with a large managed care system. This study describes patient information including demographic data, referral source, primary diagnosis, specialized diagnostic testing, and subsequent specialty consultation. RESULTS: A total of 1857 patient contacts were analyzed. New patients were referred from a full range of physicians both primary care (family practice, internal medicine, pediatrics, and emergency physicians) and other specialists, with family practice clinic providers (physicians, physician assistants, and nurse practitioners) accounting for the largest percentage of new referrals. The majority of patient visits were for orthopedic injuries (95.4%); the most frequently involved injury sites were: knee (26.5%), shoulder (18.2%), back (14.3%), and ankle (10%). The most common types of injury were: tendinitis (21.3%), chronic anterior knee pain (10.6%), and ligament sprains (9.9%). Specialized testing was requested for 8% of all patients. The majority of patients were treated at the Ft Belvoir Sports Medicine Clinic by primary care sports medicine physicians without further specialty referral. CONCLUSIONS: Primary care sports medicine physicians offer an intermediate level of care for patients while maintaining a practice in their primary care specialty. This dual practice is ideal in the managed care setting. This study demonstrates the complementary nature of primary care sports medicine and orthopedics, with the primary care sports medicine physician reducing the demand on orthopedists for nonsurgical treatment. This study also demonstrates the need for revision in the orthopedic curriculum for primary care physicians.

Adolescent↗

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Black widow spider bite.

These two cases illustrate many classical features of latrodectism. A subclinical bite followed by extensive systemic signs and symptoms in a recognizable pattern is strongly suggestive of the diagnosis. Pain and muscle spasms are refractory to standard therapy but are relieved by intravenous calcium. Finally, there should be complete resolution of the symptoms after only one vial of antivenin is administered. The common features of these cases form a recognizable constellation of signs and symptoms known as latrodectism. The specifics of these cases highlight the uncertainty of therapy. The older patient, because of the severity of his symptoms, warranted the use of antivenin perhaps earlier than it was given. The argument could be made, however, that because the patient was experiencing minimal morbidity and mortality, the calcium would have controlled his symptoms until the venom was cleared from his system. There would then have been no risk of anaphylaxis or serum sickness. One can only guess whether continued calcium use would have precipitated a hypercalcemic state and also would have been a health risk. The decision to provide antivenin therapy was made and the patient did well. The younger patient was not as severely affected as the older patient, so it could be argued that he was less in need of the antivenin. Still, his symptoms had not abated despite a reasonable length of time and might even have been considered to be worsening. No bite was found, but having discovered him playing with the spider certainly qualifies as circumstantial evidence. Also, the child was 11 months old and had greater risk of mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗