Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada.
Patient and Public Partner of Choosing Wisely Canada, Regina, SK S4S 4V4, Canada.
Int J Environ Res Public Health. 2021 Mar 9;18(5):2786. doi: 10.3390/ijerph18052786.
despite the efforts of multiple stakeholders to promote appropriate care throughout the healthcare system, studies show that two out of three lower back pain (LBP) patients expect to receive imaging. We used the Choosing Wisely Canada patient-oriented framework, prioritizing patient engagement, to develop an intervention that addresses lower back pain imaging overuse.
to develop this intervention, we collaborated with a multidisciplinary advisory team, including two patient partners with lower back pain, researchers, clinicians, healthcare administrators, and the Choosing Wisely Canada lead for Saskatchewan. For this qualitative study, data were collected through two advisory team meetings, two individual interviews with lower back pain patient partners, and three focus groups with lower back pain patient participants. A lower back pain prescription pad was developed as an outcome of these consultations.
participants reported a lack of interactive and informative communication was a significant barrier to receiving appropriate care. The most cited content information for inclusion in this intervention was treatments known to work, including physical activity, useful equipment, and reliable sources of educational material. Participants also suggested it was important that benefits and risks of imaging were explained on the pad. Three key themes derived from the data were also used to guide development of the intervention: (a) the role of imaging in LBP diagnosis; (b) the impact of the patient-physician relationship on LBP diagnosis and treatment; and (c) the lack of patient awareness of Choosing Wisely Canada and their recommendations.
the lower back pain patient-developed prescription pad may help patients and clinicians engage in informed conversations and shared decision making that could support reduce unnecessary lower back pain imaging.
尽管多方利益相关者努力在整个医疗保健系统中推动提供适当的护理，但研究表明，每三个下背痛 (LBP) 患者中就有两个期望接受影像学检查。我们使用了加拿大明智选择以患者为中心的框架，优先考虑患者的参与，制定了一项干预措施来解决下背痛影像学过度使用的问题。
为了开发这种干预措施，我们与一个多学科顾问团队合作，其中包括两名患有下背痛的患者合作伙伴、研究人员、临床医生、医疗保健管理人员和萨斯喀彻温省的加拿大明智选择领导。在这项定性研究中，通过两次顾问团队会议、两次与下背痛患者合作伙伴的单独访谈以及三次与下背痛患者参与者的焦点小组收集了数据。作为这些咨询的结果，开发了一种下背痛处方笺。
参与者报告说，缺乏互动和信息丰富的沟通是获得适当护理的一个重大障碍。最被引用的纳入干预措施的内容信息是已知有效的治疗方法，包括体育活动、有用的设备和可靠的教育材料来源。参与者还认为，在处方笺上解释影像学检查的益处和风险非常重要。从数据中还得出了三个关键主题，这些主题也用于指导干预措施的制定：(a) 影像学在 LBP 诊断中的作用；(b) 医患关系对 LBP 诊断和治疗的影响；(c) 患者对加拿大明智选择及其建议的认识不足。
由下背痛患者开发的处方笺可以帮助患者和临床医生进行知情对话和共同决策，从而有可能减少不必要的下背痛影像学检查。
