RESUMO
OBJECTIVE: To examine trends in use of acute health care services for hand fractures in a large diverse population across a range of medical settings. DESIGN: Retrospective review of data from the British Columbia Linked Health Dataset on patients who had been treated for hand fractures between May 1, 1996, and April 30, 2001. SETTING: British Columbia. PARTICIPANTS: A total of 72 481 British Columbia residents identified from the British Columbia Linked Health Dataset as having received treatment for hand fractures. MAIN OUTCOME MEASURES: Initial treatment for fractures (who had provided treatment and where had the treatment taken place) and hospital use (type of hospital, physician responsible, wait time, length of stay,geographic variation). RESULTS: Almost all patients (97%) with hand fractures received initial treatment as outpatients. Just over half these patients (54%) received initial care in nonhospital settings, and more than two-thirds (70%) received initial care from primary care physicians. By far most patients (90%) were treated conservatively without surgical intervention. The few patients with more complicated hand fractures (10%) were most commonly treated in day surgery settings by specialist surgeons within 2 days of first presentation. Patients in the more rural, isolated,northern region of British Columbia had higher hospital admission rates (relative risk 2.1) for hand fractures than patients in other regions did. CONCLUSION: In contrast to other common fracture injuries that are routinely managed by specialist surgeons,most hand fractures in BC were managed initially as nonemergency medical problems by primary care physicians. Almost all patients were treated conservatively without surgical intervention. The few patients with more complicated hand fractures were referred to and treated quickly by specialist surgeons. Focused training and continuing education opportunities for primary care physicians on new approaches to management of acute hand fractures will ensure that patients with hand fractures in British Columbia and the whole of Canada continue to benefit from appropriate management by primary care physicians.