ABSTRACT
OBJECTIVES: To measure knowledge of Israeli low back pain (LBP) clinical practice guidelines among different subgroups of primary care doctors, prior to designing an intervention programme to enhance guideline adherence in practice. STUDY DESIGN: Confidential mailed survey questionnaire. SETTING: Family practices in the Haifa and western Galilee district, Israel. PARTICIPANTS: Random sample of 163 primary care doctors. A total of 134 doctors (82%) completed the questionnaire. MAIN OUTCOME MEASURES: A Multiple Choice Questionnaire measuring knowledge of the LBP guidelines. Instrument reliability and inter-item reliability were tested in a pilot phase. Content validity was assured by having the Israeli LBP guideline authors involved in a consensus procedure. RESULTS: Distribution of test scores significantly differentiated professional levels and background variables, demonstrating the instrument reliability. Cronbach's alpha was above 0.91. The average test score was 67.7 [standard deviation (SD) 16.2], family doctors had average scores of 75.2 (SD 9.8), general practitioners (GPs) 57.9 (SD 19) and family practice residents 67.4 (SD 13.2). The difference between the test average scores of family doctors, GPs and residents was significant (P < 0.001). Significant differences were also found for specific variables including the doctor's age, country of medical training and self-report familiarity with the LBP guidelines. CONCLUSIONS: Striking differences exist between subgroups of primary care doctors regarding their knowledge of LBP guidelines. These differences will require the design of multiple interventions tailored to each subgroup.
Subject(s)
Clinical Competence/standards , Guideline Adherence/organization & administration , Health Knowledge, Attitudes, Practice , Low Back Pain , Physicians, Family/education , Practice Guidelines as Topic , Adult , Analysis of Variance , Attitude of Health Personnel , Educational Measurement , Evidence-Based Medicine/education , Female , Humans , Israel , Low Back Pain/diagnosis , Low Back Pain/therapy , Male , Middle Aged , Needs Assessment , Physicians, Family/organization & administration , Physicians, Family/psychology , Practice Patterns, Physicians'/organization & administration , Primary Health Care/organization & administration , Statistics, Nonparametric , Surveys and QuestionnairesABSTRACT
PURPOSE: Current low back pain (LBP) clinical guidelines have helped to summarize the scientific evidence and research, but have failed to provide tools and guide family physicians (FPs). The purpose of this study is to identify barriers and facilitators for the implementation of LBP guidelines from family FPs' perspective. METHODS: A qualitative focus group study of FPs in the north of Israel. Purposeful sampling was used to recruit participants, all of them board-certified FPs. Four focus groups were created, and discussions were taped, transcribed and analysed for major themes. RESULTS: Focus groups findings have expanded the understanding of the intellectual and mental challenges faced by Israeli FPs caring for LBP patients and highlighted the many obstacles to implementing LBP guidelines. Physicians' decision-making, pertaining to LBP, functions on three levels simultaneously: the physicians' agenda based on familiarity with the guidelines; their need to remain grounded in the context of the specific patient-doctor relationship; and the constraints and demands of the physician's workplace, medical system and environment. CONCLUSIONS: Despite an overall positive attitude towards LBP guideline implementation, FPs found it hard to come to terms with the conflicting dimensions of LBP patient care. The patient-doctor interaction determined the outcome of the encounter, whether it complied with the guidelines and whether the encounter leads to a healing process or to a vicious circle of unnecessary utilization of services.
