Joint and soft tissue injections in the community: questionnaire survey of general practitioners' experiences and attitudes.

OBJECTIVES: To investigate the numbers and types of joint and soft tissue injections performed by general practitioners (GPs) and to explore attitudes to training in joint and soft tissue injection and perceived barriers to performing injections.
METHODS: A self administered questionnaire was mailed to a random sample of 410 (30%) of 1367 GPs in Northern Ireland. Two mailings were used to increase the response rate. Questions explored the GPs' demographic characteristics, types and numbers of injections performed, previous training experience, attitudes towards training, and perceived barriers.
RESULTS: The overall response rate was 75%. Practitioners who were men, worked in a "rural" or "mixed" locality, and had had a previous post in rheumatology, orthopaedics, or sports medicine were more likely to perform joint and soft tissue injections. Forty six per cent of GPs did not currently perform any injections; 5% of GPs performed most of the injections in the community. Injections into the shoulder, knee, and lateral epicondylitis were found to be the most commonly performed injections. The GPs preferred to train on "real patients" rather than "mannequin models". Those GPs who had trained on "real patients" were more likely to perform injections. The main perceived barrier to performing joint and soft tissue injections in the community was the "inability to maintain injection skills".
CONCLUSION: Postgraduate training, methods of training, and the ability to maintain injection skills seemed to be determinants affecting GP confidence and the amount of joint and soft tissue injections that they performed. Most injections were performed by a few GPs in the community. These findings may have implications for the developing role of GP specialists in primary care trusts.