Breen Alan, Carr Eloise, Mann Eileen, Crossen-White Holly
Institute for Musculoskeletal Research and Clinical Implementation, Anglo-European College of Chiropractic, Bournemouth, UK. imrci@
J Nurs Manag. 2004 May;12(3):201-9. doi: 10.1111/j.1365-2834.2004.00469.x.
(1) To determine the acceptability of the Royal College of General Practitioner Guidelines to small samples of nurses, General Practitioners and acute back pain patients, (2) to determine what additional roles for nurses in the management of acute back pain in primary care might be acceptable to these samples, (3) to evaluate the responses of General Practitioners, nurses and patients to a suggested service model based on the RCGP Guidelines, (4) to identify opportunities for and barriers to the further development of such models and to obtain the appraisal of the above by an external group of assessors.
Using a qualitative design the pilot study included Primary Care (General Practitioners, Practice Nurses and Patients) with the main outcome measures as: appraisal questionnaires (for RCGP Guideline), qualitative content analysis of focus group narratives, and appraisal of process and outcomes by an external panel.
Attitudes towards the RCGP guidelines were positive, but professionals and patients alike did not think their recommendations could be implemented with the current service provision in primary care. There was criticism by professionals of the capacity for a nurse-led service within practices. Access to chiropractors, osteopaths and/or specialist physiotherapists in National Health Service primary care was raised as a need by both groups. All members of the Advisory Panel approved the processes for the recruitment of participants, focus group questions and analysis.
Barriers to implementation of the RCGP Guideline and to a nurse-led acute back pain service in general practice, were illustrated. These mainly relate to grossly inadequate capacity to deal with multidimensional patient needs, allowing progression to chronic pain states and much higher health care costs. There was a strong desire to include a different group of professionals in primary care. We recommend a local needs assessment and consideration of a national strategy for the implementation of the RCGP Guideline in primary care.
（1）确定皇家全科医师学院指南对护士、全科医师和急性背痛患者小样本的可接受性；（2）确定这些样本可能接受的护士在初级保健中急性背痛管理方面的其他角色；（3）评估全科医师、护士和患者对基于皇家全科医师学院指南的建议服务模式的反应；（4）识别此类模式进一步发展的机会和障碍，并获得外部评估小组对上述内容的评估。
采用定性设计，试点研究纳入了初级保健（全科医师、执业护士和患者），主要结局指标为：评估问卷（针对皇家全科医师学院指南）、焦点小组叙述的定性内容分析以及外部专家小组对过程和结果的评估。
对皇家全科医师学院指南的态度是积极的，但专业人员和患者都认为其建议在当前初级保健服务提供情况下无法实施。专业人员对诊所内由护士主导的服务能力提出了批评。两组都提出需要在国民保健制度初级保健中获得整脊师、整骨疗法师和/或专科物理治疗师的服务。咨询小组的所有成员都批准了参与者招募流程、焦点小组问题和分析方法。
阐述了皇家全科医师学院指南实施以及在全科医疗中由护士主导的急性背痛服务的障碍。这些主要与处理多维度患者需求的能力严重不足、导致病情发展为慢性疼痛状态以及更高的医疗保健成本有关。强烈希望在初级保健中纳入不同的专业人员群体。我们建议进行当地需求评估，并考虑在初级保健中实施皇家全科医师学院指南的国家战略。
