A multifaceted implementation strategy versus passive implementation of low back pain guidelines in general practice:
Allan Riis1, Cathrine Elgaard Jensen2, Flemming Bro3
1Department of Clinical Medicine, Research Unit for General Practice in Aalborg, Aalborg University, Fyrkildevej 7, 1.3, 9220, Aalborg, Denmark. Ariis@dcm.aau.dk.
Implementation Science : IS
|October 23, 2016
Summary
A multifaceted implementation strategy (MuIS) effectively reduced referrals for low back pain (LBP) patients to secondary care and was cost-effective. However, the MuIS approach led to decreased patient satisfaction over time.
Area of Science:
- Health Services Research
- Clinical Practice Guidelines
- Evidence-Based Medicine
Background:
- Clinical practice guidelines are often slow to be adopted into routine care.
- Active support for healthcare professionals can accelerate evidence-based treatment implementation.
- Danish low back pain (LBP) guidelines aim to reduce primary to secondary care referrals.
Purpose of the Study:
- To reduce secondary care referrals for LBP patients within 12 weeks.
- To evaluate the effectiveness of a multifaceted implementation strategy (MuIS).
- To assess the cost-effectiveness of the MuIS.
Main Methods:
- Cluster randomized design involving 189 general practices (54 included).
- Multifaceted implementation strategy (MuIS) included outreach, quality reports, and STarT Back Tool.
- Intention-to-treat analysis with patient-reported outcomes and cost-effectiveness analysis.
Main Results:
- A 52% reduction in secondary care referrals for the MuIS group compared to the passive implementation strategy (PaIS) group (AOR 0.52).
- The MuIS was cost-saving (£-93.20 per patient) after 12 weeks.
- Patients in the MuIS group reported lower satisfaction after 52 weeks (AOR 0.50).
Conclusions:
- A MuIS can effectively alter general practice referral behavior for LBP.
- The MuIS approach demonstrated cost-effectiveness in reducing referrals.
- While effective, the MuIS approach requires consideration of potential impacts on long-term patient satisfaction.
Keywords:
General practiceGuidelinesImplementationLow back painReferral and consultationTranslational Medical ResearchMore Related Videos
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