针对急性腰痛的指导方针一致的护理:对实施决定因素的混合方法分析
Kate I Minick1, Ashley Krueger2, Amelia Millward1
1Rehabilitation Services, Intermountain Health, Salt Lake City, UT, United States of America.
The American journal of emergency medicine
|December 5, 2024
概括
对于急性腰部疼痛 (LBP) 的成像和物理治疗 (PT) 使用的变化在急诊部 (ED) 和紧急护理 (UC) 之间很大. 需要实施战略来解决临床医生的障碍,并改善对LBP管理的准则遵守.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 实施科学 实施科学
- 肌肉骨健康 肌肉骨健康
背景情况:
- 急性腰部疼痛 (LBP) 是一种常见的疾病,已建立管理指南建议.
- 对于急性LBP的诊断成像和物理治疗 (PT) 的使用存在差异.
- 了解这种变化的决定因素对于优化护理提供至关重要.
研究的目的:
- 测量图像和物理治疗 (PT) 用于急性腰部疼痛 (LBP) 的变化.
- 确定解释LBP护理在急诊部 (ED) 和紧急护理 (UC) 设置中的差异的实施决定因素.
- 评估与LBP指南建议的一致性.
主要方法:
- 在22个ED和27个UC中进行了一项解释性,连续的混合方法研究.
- 对8047例急性LBP遭遇 (2023年1月至6月) 的定量分析,测量了成像和PT订单率.
- 对30名医生和APP的采访进行了定性内容分析,确定了实施决定因素.
主要成果:
- 在29%的急性LBP遭遇中,成像订单存在 (ED:43%;UC:18%);PT订单在5% (ED:7%;UC:4%).
- 临床医生熟悉LBP指导方针,但对其应用的知识和信念有显著的差异.
- 确定的障碍包括对PT的理解不同,复杂的转诊工作流程,对成像的医学法律保证感知,以及缺乏反循环.
结论:
- 对于急性LBP的成像和PT的指导方针一致性在ED和UC提供者之间存在显著差异.
- 实施策略应针对已识别的障碍,以改善对LBP准则的遵守.
- 未来的试验应该测试干预措施,以减少急性LBP的成像过度使用和PT使用不足.
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