Jenkins Hazel J, Moloney Niamh A, French Simon D, Maher Chris G, Dear Blake F, Magnussen John S, Hancock Mark J
Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia.
BMC Health Serv Res. 2018 Sep 24;18(1):734. doi: 10.1186/s12913-018-3526-7.
Imaging is overused in the management of low back pain (LBP). Interventions designed to decrease non-indicated imaging have predominantly targeted practitioner education alone; however, these are typically ineffective. Barriers to reducing imaging have been identified for both patients and practitioners. Interventions aimed at addressing barriers in both these groups concurrently may be more effective. The Behaviour Change Wheel provides a structured framework for developing implementation interventions to facilitate behavioural change. The aim of this study was to develop an implementation intervention aiming to reduce non-indicated imaging for LBP, by targeting both general medical practitioner (GP) and patient barriers concurrently.
The Behaviour Change Wheel was used to identify the behaviours requiring change, and guide initial development of an implementation intervention. Preliminary testing of the intervention was performed with: 1) content review by experts in the field; and 2) qualitative analysis of semi-structured interviews with 10 GPs and 10 healthcare consumers, to determine barriers and facilitators to successful implementation of the intervention in clinical practice. Results informed further development of the implementation intervention.
Patient pressure on the GP to order imaging, and the inability of the GP to manage a clinical consult for LBP without imaging, were determined to be the primary behaviours leading to referral for non-indicated imaging. The developed implementation intervention consisted of a purpose-developed clinical resource for GPs to use with patients during a LBP consult, and a GP training session. The implementation intervention was designed to provide GP and patient education, remind GPs of preferred behaviour, provide clinical decision support, and facilitate GP-patient communication. Preliminary testing found experts, GPs, and healthcare consumers were supportive of most aspects of the developed resource, and thought use would likely decrease non-indicated imaging for LBP. Suggestions for improvement of the implementation intervention were incorporated into a final version.
The developed implementation intervention, aiming to reduce non-indicated imaging for LBP, was informed by behaviour change theory and preliminary testing. Further testing is required to assess feasibility of use in clinical practice, and the effectiveness of the implementation intervention in reducing imaging for LBP, before large-scale implementation can be considered.
在腰痛（LBP）的管理中，影像学检查存在过度使用的情况。旨在减少不必要影像学检查的干预措施主要仅针对从业者教育；然而，这些措施通常效果不佳。已确定患者和从业者在减少影像学检查方面均存在障碍。同时针对这两组人群的障碍采取干预措施可能会更有效。行为改变轮为制定实施干预措施以促进行为改变提供了一个结构化框架。本研究的目的是通过同时针对全科医生（GP）和患者的障碍，开发一种旨在减少LBP不必要影像学检查的实施干预措施。
使用行为改变轮来确定需要改变的行为，并指导实施干预措施的初步开发。对干预措施进行了初步测试，包括：1）由该领域的专家进行内容审查；2）对10名全科医生和10名医疗保健消费者进行半结构化访谈的定性分析，以确定在临床实践中成功实施该干预措施的障碍和促进因素。结果为实施干预措施的进一步开发提供了依据。
患者向全科医生施加进行影像学检查的压力，以及全科医生在没有影像学检查的情况下无法处理LBP临床会诊，被确定为导致不必要影像学检查转诊的主要行为。所开发的实施干预措施包括为全科医生在LBP会诊期间与患者一起使用而专门开发的临床资源，以及一次全科医生培训课程。该实施干预措施旨在提供全科医生和患者教育，提醒全科医生首选行为，提供临床决策支持，并促进全科医生与患者的沟通。初步测试发现，专家、全科医生和医疗保健消费者对所开发资源的大多数方面表示支持，并认为使用该资源可能会减少LBP不必要的影像学检查。对实施干预措施的改进建议被纳入最终版本。
所开发的旨在减少LBP不必要影像学检查的实施干预措施是基于行为改变理论和初步测试得出的。在考虑大规模实施之前，需要进一步测试以评估其在临床实践中的使用可行性，以及该实施干预措施在减少LBP影像学检查方面的有效性。
