Physical Therapy Sciences, Program in Clinical Health Sciences, University Medical Centre Utrecht Brain Centre, Utrecht, Netherlands.
Institute for Musculoskeletal Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia.
Emerg Med J. 2021 Jul;38(7):529-536. doi: 10.1136/emermed-2020-210345. Epub 2021 May 27.
Overuse of lumbar imaging in the Emergency Department is a well-recognised healthcare challenge. Studies to date have not provided robust evidence that available interventions can reduce overuse. For an intervention aimed at reducing imaging to be effective, insight into how both patients and clinicians view lumbar imaging tests is essential.
To explore factors that might influence overuse of lumbar imaging in the Emergency Department.
Participants were recruited from three hospitals in Sydney, Australia between April and August 2019. We conducted focus groups and/or interviews with 14 patients and 12 clinicians. Sessions were audio-recorded and transcribed verbatim. Data were analysed using framework analysis by a team of four researchers with diverse backgrounds.
Patients described feeling that the decision about lumbar imaging was made by their Emergency Department clinician and reported little involvement in the decision-making process. Other potential drivers of lumbar imaging overuse from the patients' perspective were strong expectations for lumbar imaging, a reluctance to delay receiving a diagnosis, and requirements from third parties (eg, insurance companies) to have imaging. Emergency Department clinicians suggested that the absence of an ongoing therapeutic relationship, and the inability to manage perceived patient pressure could drive overuse of lumbar imaging. Suggested protective factors included: involving patients in the decision, ensuring clinicians have the ability to explain the reasons to avoid imaging and collaborative approaches to care both within the Emergency Department and with primary care.
We found several factors that could contribute to overuse of lumbar imaging in the Emergency Department. Solutions to overuse of lumbar imaging in the Emergency Department could include: (1) strategies to involve patients in decisions about imaging; (2) training and support to provide thorough and well explained clinical assessment for low back pain; and (3) systems that support collaborative approaches to care.
在急诊科过度使用腰椎影像学检查是一个众所周知的医疗保健挑战。迄今为止的研究并未提供有力证据表明现有的干预措施可以减少过度使用。为了使针对减少影像学检查的干预措施有效，了解患者和临床医生如何看待腰椎影像学检查至关重要。
探讨可能影响急诊科腰椎影像学过度使用的因素。
2019 年 4 月至 8 月，我们在澳大利亚悉尼的 3 家医院招募了参与者。我们对 14 名患者和 12 名临床医生进行了焦点小组讨论和/或访谈。会议进行了录音，并逐字记录。由具有不同背景的四名研究人员组成的团队使用框架分析法对数据进行分析。
患者描述说，他们觉得腰椎影像学检查的决定是由急诊科临床医生做出的，并且他们在决策过程中几乎没有参与。从患者的角度来看，导致腰椎影像学过度使用的其他潜在驱动因素包括对腰椎影像学检查的强烈期望、不愿延迟获得诊断，以及第三方（如保险公司）对影像学检查的要求。急诊科临床医生认为，缺乏持续的治疗关系，以及无法应对患者的压力，可能会导致腰椎影像学过度使用。他们建议的保护因素包括：让患者参与决策、确保临床医生有能力解释避免影像学检查的原因，以及在急诊科内部和与初级保健机构之间建立协作式的护理方法。
我们发现了一些可能导致急诊科腰椎影像学过度使用的因素。解决急诊科腰椎影像学过度使用的方法可能包括：（1）让患者参与影像学检查决策的策略；（2）培训和支持，为腰痛提供全面和充分解释的临床评估；（3）支持协作式护理方法的系统。
