Dpt. of General Practice, University of Göttingen, Humboldtallee 38, 37073 Goettingen, Germany.
Implement Sci. 2008 Feb 7;3:7. doi: 10.1186/1748-5908-3-7.
Implementation of guidelines in clinical practice is difficult. In 2003, the German College of General Practitioners and Family Physicians (DEGAM) released an evidence-based guideline for the management of low back pain (LBP) in primary care. The objective of this study is to explore the acceptance of guideline content and perceived barriers to implementation.
Seventy-two general practitioners (GPs) participating in quality circles within the framework of an educational intervention study for guideline implementation evaluated the LBP-guideline and its practicability with a standardised questionnaire. In addition, statements of group discussions were recorded using the metaplan technique and were incorporated in the discussion.
Most GPs agree with the guideline content but believe that guideline stipulations are not congruent with patient wishes. Non-adherence to the guideline and contradictory information for patients by other professionals (e.g., GPs, orthopaedic surgeons, physiotherapists) are important barriers to guideline adherence. Almost half of the GPs have no access to recommended multimodal pain programs for patients with chronic LBP.
Promoting adherence to the LBP guideline requires more than enhancing knowledge about evidence-based management of LBP. Public education and an interdisciplinary consensus are important requirements for successful guideline implementation into daily practice. Guideline recommendations need to be adapted to the infrastructure of the health care system.
临床实践中指南的实施具有一定难度。2003 年，德国全科医师和家庭医生学会（DEGAM）发布了针对初级保健中腰痛（LBP）管理的循证指南。本研究旨在探讨指南内容的接受程度和实施障碍的认知。
72 名参与教育干预研究中质量圈的全科医生（GPs），用标准化问卷评估 LBP 指南及其实用性。此外，使用元计划技术记录小组讨论的内容，并将其纳入讨论。
大多数 GPs 同意指南内容，但认为指南规定与患者意愿不符。不遵守指南和其他专业人员（如全科医生、骨科医生、物理治疗师）提供的相互矛盾的信息是指南实施的重要障碍。近一半的 GPs 无法为慢性 LBP 患者提供推荐的多模式疼痛方案。
促进对 LBP 指南的遵循，不仅仅需要提高对 LBP 循证管理的认识。公众教育和跨学科共识是成功将指南实施到日常实践中的重要要求。指南建议需要适应医疗保健系统的基础设施。
