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“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
“Lovely pie in the sky plans”: a qualitative study of clinicians’ perspectives on guidelines for managing low back pain in primary care in England
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 terminology-"non-specific LBP"-unfamiliar 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.
0362-2436
1842-1850
Bishop, Felicity L.
1f5429c5-325f-4ac4-aae3-6ba85d079928
Dima, A.L.
79609156-09f5-4bf3-a46e-1a344e687d40
Ngui, J.
91dd5077-e0b4-422d-bad5-d90ff2a503a9
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Moss-Morris, Rona
a502f58a-d319-49a6-8aea-9dde4efc871e
Foster, N.E.
de654772-b75f-444b-a6db-55e990aabb3b
Lewith, George
0fc483fa-f17b-47c5-94d9-5c15e65a7625
Bishop, Felicity L.
1f5429c5-325f-4ac4-aae3-6ba85d079928
Dima, A.L.
79609156-09f5-4bf3-a46e-1a344e687d40
Ngui, J.
91dd5077-e0b4-422d-bad5-d90ff2a503a9
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Moss-Morris, Rona
a502f58a-d319-49a6-8aea-9dde4efc871e
Foster, N.E.
de654772-b75f-444b-a6db-55e990aabb3b
Lewith, George
0fc483fa-f17b-47c5-94d9-5c15e65a7625

Bishop, Felicity L., Dima, A.L., Ngui, J., Little, Paul, Moss-Morris, Rona, Foster, N.E. and Lewith, George (2015) “Lovely pie in the sky plans”: a qualitative study of clinicians’ perspectives on guidelines for managing low back pain in primary care in England. Spine, 40 (23), 1842-1850. (PMID:26571064)

Record type: Article

Abstract

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 terminology-"non-specific LBP"-unfamiliar 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.

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Accepted/In Press date: 5 August 2015
Published date: December 2015
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 380811
URI: https://eprints.soton.ac.uk/id/eprint/380811
ISSN: 0362-2436
PURE UUID: b26b4699-46cc-487c-bd1c-6534d81d0799
ORCID for Felicity L. Bishop: ORCID iD orcid.org/0000-0002-8737-6662

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Date deposited: 21 Sep 2015 08:00
Last modified: 06 Jun 2018 12:47

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