Schers H, Wensing M, Huijsmans Z, van Tulder M, Grol R
Centre for Quality of Care Research, University Medical Centre St. Radboud, Nijmegen, The Netherlands.
Spine (Phila Pa 1976). 2001 Aug 1;26(15):E348-53. doi: 10.1097/00007632-200108010-00013.
Qualitative study design, using semi-structured interviews.
To explore factors that determine non-adherence to the guidelines for low back pain.
Guidelines for low back pain have been published in the past decade in various countries. In the Netherlands, general practitioners adhere to them to a fair extent, and it is unclear whether room for improvement remains.
Forty semistructured, in-depth interviews were conducted with twenty patients who consulted for low back pain, and with their general practitioners. The interviews were fully transcribed and analyzed qualitatively.
Patients often had limited expectations of the consultation. They wanted to hear a diagnosis or expected to receive simple advice. The general practitioners said they were well informed about the guideline and mostly agreed with its content. Reasons for non-adherence were mainly related to patients' experiences in the past and general practitioners' interpretations of their preferences. General practitioners stated that they were inclined to give in to patients' demands, for example the request for radiographic films or a referral to a physical therapist. In general, patients and their general practitioners were satisfied with the chosen management.
Improvement of the quality of back pain care may still be possible. Implementation strategies should aim at training physicians in communication skills, especially about subjects for debate, where patients' beliefs and experiences color their expectations.
采用半结构式访谈的定性研究设计。
探讨决定不遵循腰痛指南的因素。
过去十年间，各国已发布腰痛指南。在荷兰，全科医生在一定程度上遵循这些指南，尚不清楚是否仍有改进空间。
对20名因腰痛前来就诊的患者及其全科医生进行了40次半结构式深入访谈。访谈内容全部转录并进行定性分析。
患者对诊疗的期望往往有限。他们希望听到诊断结果或得到简单建议。全科医生表示他们对指南了如指掌，且大多认同其内容。不遵循指南的原因主要与患者过去的经历以及全科医生对患者偏好的解读有关。全科医生称他们倾向于满足患者的要求，比如患者要求拍X光片或转诊至物理治疗师。总体而言，患者及其全科医生对所选的治疗方案感到满意。
改善腰痛护理质量仍有可能。实施策略应旨在培训医生的沟通技巧，尤其是关于存在争议的话题，因为患者的信念和经历会影响他们的期望。
