Perceptions of general practitioners towards the use of a new system for treating back pain: a qualitative interview study
Perceptions of general practitioners towards the use of a new system for treating back pain: a qualitative interview study
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DOI：
10.1186/1741-7015-9-49
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发表时间：
2011-05-09
期刊：
影响因子：
9.3
通讯作者：
Ong, Bie Nio
中科院分区：
文献类型：
--
作者：
Sanders, Tom;Foster, Nadine E.;Ong, Bie Nio
背景：改变临床医生的行为被认为是一个重大挑战。很明显，行为改变不仅取决于证明临床干预措施的有效性;环境和职业因素，如“改变准备”，可能是其实施的核心。本文重点介绍了在初级保健的医疗创新的行为变化的背景下，突出的组织和人际因素，可能有助于解释的动态implementation.Methods：定性访谈进行了全科医生（GP）之前（n = 32）和之后（n = 9）引入一个分组为目标的治疗系统的重要性。为全科医生提供了一个电子六项亚组工具，根据患者预后不良的风险（“高”，“低”）来识别患者，以帮助他们做出有关治疗方法的决策。招聘是基于“最大限度多样化的样本”，以获得广泛的代表性的意见，所有五个业务。一个编码方案的基础上开发的新兴的调查结果，数据进行了分析，使用“不断比较”，借鉴的见解和发展主题之间的联系。我们采用了正常化过程理论（NPT）来解释吸收的新系统，并检查相关的一致性，为实施创新organization.Results：全科医生认为背痛作为一个低临床优先级，并强调了“实用”和“关系”的一致性的重要性，在决定采用和从事新的亚组有针对性的治疗系统。卫生专业人员经常对新的创新进行“意义建构”，以“道路测试”其适用性或与日常临床程序的相关性。全科医生普遍认为腰痛是一种“无趣”且在临床上没有挑战性的健康问题，这可能在一定程度上解释了他们缺乏对靶向治疗系统新亚组的参与。通过这种新的工作方式的全科医生确定的意义，他们归因于它在他们的日常临床routes.Conclusions的背景下：我们得出结论，实施新的子组有针对性的治疗系统，在初级保健腰痛的关键障碍是一个最初的失败，以实现“连贯性”所需的实践改变与全科医生。尽管如此，全科医生在不同程度上使用了该工具，尽管这表明他们普遍致力于参与研究，而不是对新系统的更深层次的态度变化。
Background: Changing clinicians' behaviour is recognised as a major challenge. It is clear that behaviour change not only depends on demonstrating the proven effectiveness of clinical interventions; contextual and occupational factors, such as 'change readiness', may be central to their implementation. This paper highlights the context of behaviour change in relation to a healthcare innovation introduced within primary care, highlighting the importance of organisational and interpersonal factors that may help explain the dynamics of implementation.Methods: Qualitative interviews were conducted with general practitioners (GPs) before (n = 32) and after (n = 9) the introduction of a subgrouping for targeted treatment system. GPs were offered an electronic six-item subgrouping tool, to identify patients according to their risk of poor outcome ('high', 'low') in order to help inform their decision making about treatment approaches. Recruitment was based on a 'maximum diversification sample', to obtain a wide representation of views across all five practices. A coding scheme was developed based on the emergent findings, and the data were analysed using 'constant comparison', drawing upon insights and developing connections between themes. We adopted the normalisation process theory (NPT) to explain the uptake of the new system and to examine the relevance of coherence for the implementation of innovations in organisations.Results: GPs perceived back pain as a low clinical priority, and highlighted the importance of 'practical' and 'relational' coherence in decisions to adopt and engage with the new subgrouping for targeted treatment system. Health professionals often engage in 'sense making' about new innovations to 'road test' their applicability or relevance to daily clinical routines. Low back pain was generally perceived as an 'uninteresting' and clinically unchallenging health problem by GPs, which may partly explain their lack of engagement with the new subgrouping for targeted treatment system. The adoption of this new way of working by GPs was determined by the meaning that they ascribed to it in the context of their daily clinical routines.Conclusions: We conclude that the key obstacle to implementation of the new subgrouping for targeted treatment system for low back pain in primary care was an initial failure to achieve 'coherence' of the desired practice change with GPs. Despite this, GPs used the tool to different degrees, though this signified a general commitment to participating in the study rather than a deeper attitude change towards the new system.