Espeland Ansgar, Baerheim Anders
Section of Radiology, Institute of Surgical Sciences, University of Bergen, Haukeland University Hospital, N-5021 Bergen, Norway.
BMC Health Serv Res. 2003 Mar 24;3(1):8. doi: 10.1186/1472-6963-3-8.
General practitioners often diverge from clinical guidelines regarding spine radiography. This study aimed to identify and describe A) factors general practitioners consider may affect their decisions about ordering plain radiography for back pain and B) barriers to guideline adherence suggested by such factors.
Focus group interviews regarding factors affecting ordering decisions were carried out on a diverse sample of Norwegian general practitioners and were analysed qualitatively. Results of this study and two qualitative studies from the Netherlands and USA on use of spine radiography were interpreted for barriers to guideline adherence. These were compared with an existing barrier classification system described by Dr Cabana's group.
The factors which Norwegian general practitioners considered might affect their decisions about ordering plain radiography for back pain concerned the following broader issues: clinical ordering criteria, patients' wishes for radiography and the general practitioner's response, uncertainty, professional dignity, access to radiology services, perception of whether the patient really was ill, sense of pressure from other health care providers/social security, and expectations about the consequences of ordering radiography. The three studies suggested several attitude-related and external barriers as classified in a previously reported system described by Dr Cabana in another study. Identified barriers not listed in this system were: lack of expectancy that guideline adherence will lead to desired health care process, emotional difficulty with adherence, improper access to actual/alternative health care services, and pressure from health care providers/organisations.
Our findings may help implement spine radiography guidelines. They also indicate that Cabana et al.'s barrier classification system needs extending. A revised system is proposed.
全科医生在脊柱X光检查方面常常偏离临床指南。本研究旨在识别并描述：A）全科医生认为可能影响其针对背痛开具普通X光检查单决策的因素；B）这些因素所表明的遵循指南的障碍。
对挪威全科医生的不同样本进行了关于影响开单决策因素的焦点小组访谈，并进行了定性分析。本研究结果以及荷兰和美国关于脊柱X光检查使用情况的两项定性研究结果被解读为遵循指南的障碍。将这些结果与卡巴纳博士团队描述的现有障碍分类系统进行了比较。
挪威全科医生认为可能影响其针对背痛开具普通X光检查单决策的因素涉及以下更广泛的问题：临床开单标准、患者对X光检查的意愿及全科医生的回应、不确定性、职业尊严、获得放射科服务的机会、对患者是否真的患病的认知、来自其他医疗服务提供者/社会保障的压力感，以及对开具X光检查单后果的预期。这三项研究表明了若干与态度相关的和外部的障碍，正如卡巴纳博士在另一项研究中所描述的先前报告系统中的分类那样。该系统未列出的已识别障碍有：缺乏对遵循指南会带来期望的医疗过程的预期、遵循指南存在情感困难、无法正确获得实际/替代医疗服务，以及来自医疗服务提供者/组织的压力。
我们的研究结果可能有助于实施脊柱X光检查指南。它们还表明卡巴纳等人的障碍分类系统需要扩展。本文提出了一个修订后的系统。
