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首页> 外文期刊>BMC Family Practice >Using theory to improve low back pain care in Australian Aboriginal primary care: a mixed method single cohort pilot study
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Using theory to improve low back pain care in Australian Aboriginal primary care: a mixed method single cohort pilot study

机译：利用理论改善澳大利亚原住民初级保健的腰痛护理：一项混合方法单队列研究

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Background Low back pain (LBP) care is frequently discordant with research evidence. This pilot study evaluated changes in LBP care following a systematic, theory informed intervention in a rural Australian Aboriginal Health Service. We aimed to improve three aspects of care; reduce inappropriate LBP radiological imaging referrals, increase psychosocial oriented patient assessment and, increase the provision of LBP self-management information to patients. Methods Three interventions to improve care were developed using a four-step systematic implementation approach. A mixed methods pre/post cohort design evaluated changes in the three behaviours using a clinical audit of LBP care in a six month period prior to the intervention and then following implementation. In-depth interviews elicited the perspectives of involved General Practitioners (GPs). Qualitative analysis was guided by the theoretical domains framework. Results The proportion of patients who received guideline inconsistent imaging referrals (GICI) improved from 4.1 GICI per 10 patients to 0.4 (95?% CI for decrease in rate: 1.6 to 5.6) amongst GPs involved in the intervention. Amongst non-participating GPs (locum/part-time GPs who commenced post-interventions) the rate of GICI increased from 1.5 to 4.4 GICI per 10 patients (95 % CI for increase in rate: .5 to 5.3). There was a modest increase in the number of patients who received LBP self-management information from participating GPs and no substantial changes to psychosocial oriented patient assessments by any participants; however GPs qualitatively reported that their behaviours had changed. Knowledge and beliefs about consequences were important behavioural domains related to changes. Environmental and resource factors including protocols for locum staff and clinical tools embedded in patient management software were future strategies identified. Conclusions A systematic intervention model resulted in partial improvements in LBP care. Determinants of practice change amongst GPs were increased knowledge of clinical guidelines, education delivered by someone considered a trusted source of information, and awareness of the negative consequences of inappropriate practices, especially radiological imaging on patient outcomes. Inconsistent and non-evidence based practices amongst locum GPs was an issue that emerged and will be a significant future challenge. The systematic approach utilised is applicable to other services interested in improving LBP care.
机译：背景技术腰背痛（LBP）护理常常与研究证据不一致。这项前瞻性研究评估了在农村澳大利亚原住民卫生服务局进行的系统的，理论依据的干预后，LBP护理的变化。我们旨在改善护理的三个方面：减少不适当的LBP放射影像转诊，增加以心理社会为导向的患者评估，并增加向患者提供LBP自我管理信息的能力。方法采用四步系统实施方法，开发了三种改善护理的干预措施。在干预前和实施后的六个月内，采用队列研究前后的混合方法，通过对LBP护理的临床审核，评估了三种行为的变化。深入的访谈引出了相关全科医生的观点。定性分析以理论领域框架为指导。结果在参与干预的GP中，接受指导性影像不一致转诊（GICI）的患者比例从每10例4.1 GICI提高到0.4（95％CI，降低率从1.6降至5.6）。在非参与的全科医生中（介入后开始的地方/兼职全科医生），GICI的比率从每10名患者1.5上升到4.4 GICI（95％CI，比率从0.5上升到5.3）。从参与的全科医生那里获得LBP自我管理信息的患者人数有所增加，并且任何参与者对以社会心理为导向的患者评估没有实质性改变;但是，全科医生定性报告他们的行为已经改变。关于后果的知识和信念是与变化相关的重要行为领域。环境和资源因素，包括临时工作人员的协议和患者管理软件中嵌入的临床工具，已成为未来的策略。结论系统的干预模型可改善LBP的护理水平。全科医生之间实践改变的决定因素包括对临床指南的了解增加，被认为是可信赖信息来源的人提供的教育以及对不适当做法，尤其是放射成像对患者预后的负面影响的认识。普通家庭医生之间不一致和不循证的做法是一个已出现的问题，它将是未来的重大挑战。所采用的系统方法适用于对改善LBP护理感兴趣的其他服务。

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