Abstract
BackgroundGeneral practitioners often diverge from clinical guidelines regarding spine radiography. This study aimed to identify and describe A) factors general practitioners consider may affect their decisions about ordering plain radiography for back pain and B) barriers to guideline adherence suggested by such factors.MethodsFocus group interviews regarding factors affecting ordering decisions were carried out on a diverse sample of Norwegian general practitioners and were analysed qualitatively. Results of this study and two qualitative studies from the Netherlands and USA on use of spine radiography were interpreted for barriers to guideline adherence. These were compared with an existing barrier classification system described by Dr Cabana's group.ResultsThe factors which Norwegian general practitioners considered might affect their decisions about ordering plain radiography for back pain concerned the following broader issues: clinical ordering criteria, patients' wishes for radiography and the general practitioner's response, uncertainty, professional dignity, access to radiology services, perception of whether the patient really was ill, sense of pressure from other health care providers/social security, and expectations about the consequences of ordering radiography. The three studies suggested several attitude-related and external barriers as classified in a previously reported system described by Dr Cabana in another study. Identified barriers not listed in this system were: lack of expectancy that guideline adherence will lead to desired health care process, emotional difficulty with adherence, improper access to actual/alternative health care services, and pressure from health care providers/organisations.ConclusionsOur findings may help implement spine radiography guidelines. They also indicate that Cabana et al.'s barrier classification system needs extending. A revised system is proposed.
Highlights
General practitioners often diverge from clinical guidelines regarding spine radiography
Clinical practice often diverges from clinical practice guidelines and this is well illustrated by general practitioners' (GPs') referrals for plain radiography of the lumbar spine
Quantitative studies [13,14,15,16] indicate that factors affecting GPs' use of spine radiography include clinical data, patient expectations, and GPs' wish to reassure the patients or themselves
Summary
General practitioners often diverge from clinical guidelines regarding spine radiography. This study aimed to identify and describe A) factors general practitioners consider may affect their decisions about ordering plain radiography for back pain and B) barriers to guideline adherence suggested by such factors. Changing clinical practice requires an understanding of the factors that affect it [11,12]. Quantitative studies [13,14,15,16] indicate that factors affecting GPs' use of spine radiography include clinical data, patient expectations, and GPs' wish to reassure the patients or themselves. Qualitative studies are needed to explore the full range of relevant factors and their meaning to the clinician [12,17,18]
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