Benning Leo, Köhne Nora, Busch Hans-Jörg, Hans Felix Patricius
University Emergency Center, Medical Center - University of Freiburg, Sir-Hans-A.-Krebs-Straße, 79106, Freiburg, Germany.
Emergency Department Campus Virchow-Klinikum Internal Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-University Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Int J Emerg Med. 2024 Sep 11;17(1):121. doi: 10.1186/s12245-024-00694-2.
Increasing numbers of patients treated in the emergency departments pose challenges to delivering timely and high-quality care. Particularly, the presentation of patients with low-urgency complaints consumes resources needed for patients with higher urgency. In this context, patients with non-specific back pain (NSBP) often present to emergency departments instead of primary care providers. While patient perspectives are well understood, this study aims to add a provider perspective on the diagnostic and therapeutic approach for NSBP in emergency and primary care settings.
In a qualitative content analysis, we interviewed seven Emergency Physicians (EP) and nine General Practitioners (GP) using a semi-structured interview to assess the diagnostic and therapeutic approach to patients with NSBP in emergency departments and primary care practices. A hypothetical case of NSBP was presented to the interviewees, followed by questions on their diagnostic and therapeutic approaches. Recruitment was stopped after reaching saturation of the qualitative content analysis. Reporting this work follows the consolidated criteria for reporting qualitative research (COREQ) checklist.
EPs applied two different strategies for the workup of NSBP. A subset pursued a guideline-compliant diagnostic approach, ruling out critical conditions and managing pain without extensive diagnostics. Another group of EPs applied a more extensive approach, including extensive diagnostic resources and specialist consultations. GPs emphasized physical examinations and stepwise treatment, including scheduled follow-ups and a better knowledge of the patient history to guide diagnostics and therapy. Both groups attribute ED visits for NSBP to patient related and healthcare system related factors: lack of understanding of healthcare structures, convenience, demand for immediate diagnostics, and fear of serious conditions. Furthermore, both groups reported an ill-suited healthcare infrastructure with insufficiently available primary care services as a contributing factor.
The study highlights a need for improving guideline adherence in younger EPs and better patient education on the healthcare infrastructure. Furthermore, improving access and availability of primary care services could reduce ED visits of patients with NSBP.
No trial registration needed.
急诊科就诊患者数量不断增加，这对提供及时、高质量的医疗服务构成了挑战。特别是，低紧急程度主诉患者的就诊消耗了高紧急程度患者所需的资源。在这种情况下，非特异性背痛（NSBP）患者常前往急诊科而非初级保健提供者处就诊。虽然患者的观点已得到充分理解，但本研究旨在从提供者的角度探讨急诊科和初级保健环境中NSBP的诊断和治疗方法。
在一项定性内容分析中，我们采用半结构化访谈对7名急诊科医生（EP）和9名全科医生（GP）进行了访谈，以评估急诊科和初级保健机构中NSBP患者的诊断和治疗方法。向受访者呈现了一个NSBP的假设病例，随后询问他们的诊断和治疗方法。在定性内容分析达到饱和后停止招募。本研究遵循定性研究报告统一标准（COREQ）清单进行报告。
急诊科医生对NSBP的检查采用了两种不同的策略。一部分人采用符合指南的诊断方法，排除关键病症并在不进行广泛诊断的情况下管理疼痛。另一组急诊科医生采用了更广泛的方法，包括广泛的诊断资源和专家会诊。全科医生强调体格检查和逐步治疗，包括定期随访以及更好地了解患者病史以指导诊断和治疗。两组都将NSBP患者前往急诊科就诊归因于患者相关因素和医疗系统相关因素：对医疗结构缺乏了解、便利性、对即时诊断的需求以及对严重病症的恐惧。此外，两组都报告称医疗基础设施不合适，初级保健服务供应不足是一个促成因素。
该研究强调需要提高年轻急诊科医生对指南的依从性，并更好地对患者进行医疗基础设施方面的教育。此外，改善初级保健服务的可及性和可用性可以减少NSBP患者前往急诊科就诊的次数。
无需试验注册。
