"Lovely Pie in the Sky Plans'': A Qualitative Study of Clinicians' Perspectives on Guidelines for Managing Low Back Pain in Primary Care in England
"Lovely Pie in the Sky Plans'': A Qualitative Study of Clinicians' Perspectives on Guidelines for Managing Low Back Pain in Primary Care in England
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DOI：
10.1097/brs.0000000000001215
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发表时间：
2015-12-01
期刊：
影响因子：
3
通讯作者：
Lewith, George T.
中科院分区：
文献类型：
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作者：
Bishop, Felicity L.;Dima, Alexandra L.;Lewith, George T.
研究设计：一项英格兰西南部初级保健的定性研究。目的：阐明初级保健中对腰痛（LBP）患者进行特定治疗的决策过程，并检查临床医生对英国国家健康与护理卓越研究所（NICE）的看法。在初级保健中管理LBP的临床指南。背景资料摘要仅仅发表临床指南是不足以确保其实施的。深入了解临床医生对特定临床指南的观点，可以建议如何提高临床实践指南的相关性。方法：我们进行了半结构化访谈，53个有目的的抽样临床医生。参与者是16名全科医生（GP），10名脊椎按摩师，8名针灸师，8名物理治疗师，7名骨科医生和4名护士，来自公共部门（20），私营部门（21）或两者兼而有之（12）。我们使用主题分析。结果。官方指南仅包括临床决策的许多输入之一。临床医生利用个人经验和跨专业网络，并受到组织因素的限制，当决定哪种治疗处方，参考，或提供给个别患者与LBP。有些人认为指南术语不具体，不熟悉，与实践的相关性有限。他们感到沮丧的建议之间的差距，在指南和现实世界的情况下，咨询时间短，难以访问的专家服务，稀疏委托指南推荐的treatment.Conclusion. NICE指南管理LBP在初级保健是一个，相对外围，影响全科医生，脊医，针灸师，物理治疗师，骨科医生和护士之间的临床决策。修订后，这些指南可通过以下方式与临床更加相关：确保指南术语反映临床实践术语;消除指南僵化和禁止以患者为中心的护理的形象;为临床医生提供机会参与指南推荐的补充疗法的经验学习;并为公共部门患者委托指南推荐的治疗。证据等级：N/A。
Study Design.A qualitative study in south-west England primary care.Objective.To clarify the decision-making processes that result in the delivery of particular treatments to patients with low back pain (LBP) in primary care and to examine clinicians' perspectives on the English National Institute for Health and Care Excellence (NICE) clinical guidelines for managing LBP in primary care.Summary of Background Data.Merely publishing clinical guidelines is known to be insufficient to ensure their implementation. Gaining an in-depth understanding of clinicians' perspectives on specific clinical guidelines can suggest ways to improve the relevance of guidelines for clinical practice.Methods.We conducted semi-structured interviews with 53 purposively sampled clinicians. Participants were 16 general practitioners (GPs), 10 chiropractors, 8 acupuncturists, 8 physiotherapists, 7 osteopaths, and 4 nurses, from the public sector (20), private sector (21), or both (12). We used thematic analysis.Results.Official guidelines comprised just 1 of many inputs to clinical decision-making. Clinicians drew on personal experience and inter-professional networks and were constrained by organizational factors when deciding which treatment to prescribe, refer for, or deliver to an individual patient with LBP. Some found the guideline terminologynon-specific LBPunfamiliar and of limited relevance to practice. They were frustrated by disparities between recommendations in the guidelines and the real-world situation of short consultation times, difficult-to-access specialist services, and sparse commissioning of guideline-recommended treatments.Conclusion.The NICE guidelines for managing LBP in primary care are one, relatively peripheral, influence on clinical decision-making among GPs, chiropractors, acupuncturists, physiotherapists, osteopaths, and nurses. When revised, these guidelines could be made more clinically relevant by: ensuring that guideline terminology reflects clinical practice terminology; dispelling the image of guidelines as rigid and prohibiting patient-centered care; providing opportunities for clinicians to engage in experiential learning about guideline-recommended complementary therapies; and commissioning guideline-recommended treatments for public sector patients.Level of Evidence: N/A.