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Explaining variation in GP referral rates for x-rays for back pain
Rachel Baker1, Jan Lecouturier, Senga Bond
1School of Population and Health Sciences, University of Newcastle upon Tyne, Newcastle upon Tyne, UK. r.m.baker@ncl.ac.uk
Implementation Science : IS
|August 4, 2006
Summary
General practitioners (GPs) vary in lumbar spine x-ray (LSX) referrals for low back pain (LBP) due to factors beyond guidelines, including patient reassurance and perceived management pessimism. Targeting these factors is key for adherence.
Area of Science:
- Radiology
- General Practice
- Health Services Research
Background:
- Clinical guidelines exist for low back pain (LBP) management.
- General practitioners (GPs) show significant variation in lumbar spine x-ray (LSX) referral rates.
- Understanding this variation is crucial for improving healthcare practices.
Purpose of the Study:
- To explore the reasons behind the variation in GPs' referral rates for LSX in patients with LBP.
- To identify factors influencing GPs' decisions to order LSX, beyond established guidelines.
Main Methods:
- Qualitative study involving semi-structured interviews with 29 GPs.
- GPs were selected based on high and low LSX referral rates in North East England.
- Thematic analysis with constant comparative techniques was employed.
Main Results:
- Both high and low referral groups were aware of LBP guidelines and faced patient/institutional pressures for LSX.
- High-referring GPs believed LSX offered patient reassurance, expressed pessimism about LBP management, and feared damaging doctor-patient relationships.
- GPs' awareness of their own referral rates compared to peers and perceived radiation risks were key differentiating themes.
Conclusions:
- Factors beyond clinical guidelines significantly influence GPs' LSX referral decisions for LBP.
- Interventions to improve adherence to LSX guidelines should address GPs' beliefs about reassurance, management pessimism, and doctor-patient dynamics.
- Targeting these specific factors in primary care is essential for behavior change.