Abstract
BackgroundBack pain is one of the UK's costliest and least understood health problems, whose prevalence still seems to be increasing. Educational interventions for general practitioners on back pain appear to have had little impact on practice, but these did not include quality improvement learning, involve patients in the learning, record costs or document practice activities as well as patient outcomes.MethodsWe assessed the outcome of providing information about quality improvement techniques and evidence-based practice for back pain using the Clinical Value Compass. This included clinical outcomes (Roland and Morris Disability Questionnaire), functional outcomes, costs of care and patient satisfaction. We provided workshops which used an action learning approach and collected before and after data on routine practice activity from practice electronic databases. In parallel, we studied outcomes in a separate cohort of patients with acute and sub-acute non-specific back pain recruited from the same practices over the same time period. Patient data were analysed as a prospective, split-cohort study with assessments at baseline and eight weeks following the first consultation.ResultsData for 1014 patients were recorded in the practice database study, and 101 patients in the prospective cohort study. We found that practice activities, costs and patient outcomes changed little after the intervention. However, the intervention was associated with a small, but statistically significant reduction in disability in female patients. Additionally, baseline disability, downheartedness, self-rated health and leg pain had small but statistically significant effects (p < 0.05) on follow-up disability scores in some subgroups.ConclusionsGP education for back pain that both includes health improvement methodologies and involves patients may yield additional benefits for some patients without large changes in patterns of practice activity. The effects in this study were small and limited and the reasons for them remain obscure. However, such is the impact of back pain and its frequency of consultation in general practice that this kind of improvement methodology deserves further consideration.Trial registration numberISRCTN: ISRCTN30420389
Highlights
Back pain is one of the UK’s costliest and least understood health problems, whose prevalence still seems to be increasing
Qualitative studies into general practitioner (GP) attitudes to back pain have suggested that including education and feedback could be promising [8,9,10,11], randomised trials have been less positive
Three such trials found that GP education did not by itself improve patient outcomes in terms of symptoms, disability, or satisfaction with care [12] it did modestly increase guideline consistent behaviour [13], and GP confidence [14]
Summary
Back pain is one of the UK’s costliest and least understood health problems, whose prevalence still seems to be increasing. Qualitative studies into general practitioner (GP) attitudes to back pain have suggested that including education and feedback could be promising [8,9,10,11], randomised trials have been less positive. Three such trials found that GP education did not by itself improve patient outcomes in terms of symptoms, disability, or satisfaction with care [12] it did modestly increase guideline consistent behaviour [13], and GP confidence [14]. An Italian cohort study which assessed the efficiency of an educational program on the clinical behaviour of doctors for the diagnosis of low back pain reported a shift of priorities from diagnosis to communication with patients [16]
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