Abstract：
Low back pain (LBP) is a leading cause of disability and is among the top five reasons that patients visit their family doctors. Over-imaging for non-specific low back pain remains a problem in primary care. To inform a larger study to develop and evaluate a theory-based intervention to reduce inappropriate imaging, we completed an assessment of the barriers and facilitators to reducing unnecessary imaging for NSLBP among family doctors in Newfoundland and Labrador (NL).
This was an exploratory, qualitative study describing family doctors\' experiences and practices related to diagnostic imaging for non-specific LBP in NL, guided by the Theoretical Domains Framework (TDF). Data were collected using in-depth, semi-structured interviews. Transcripts were analyzed deductively (assigning text to one or more domains) and inductively (generating themes at each of the domains) before the results were examined to determine which domains should be targeted to reduce imaging.
Nine family doctors (four males; five females) working in community (n = 4) and academic (n = 5) clinics in both rural (n = 6) and urban (n = 3) settings participated in this study. We found five barriers to reducing imaging for patients with NSLBP: 1) negative consequences, 2) patient demand 3) health system organization, 4) time, and 5) access to resources. These were related to the following domains: 1) beliefs about consequences, 2) beliefs about capabilities, 3) emotion, 4) reinforcement, 5) environmental context and resources, 6) social influences, and 7) behavioural regulation.
Family physicians a) fear that if they do not image they may miss something serious, b) face significant patient demand for imaging, c) are working in a system that encourages unnecessary imaging, d) don\'t have enough time to counsel patients about why they don\'t need imaging, and e) lack access to appropriate practitioners, community programs, and treatment modalities to prescribe to their patients. These barriers were related to seven TDF domains. Successfully reducing inappropriate imaging requires a comprehensive intervention that addresses these barriers using established behaviour change techniques. These techniques should be matched directly to relevant TDF domains. The results of our study represent the important first step of this process - identifying the contextual barriers and the domains to which they are related.
This was an exploratory, qualitative study describing family doctors\' experiences and practices related to diagnostic imaging for non-specific LBP in NL, guided by the Theoretical Domains Framework (TDF). Data were collected using in-depth, semi-structured interviews. Transcripts were analyzed deductively (assigning text to one or more domains) and inductively (generating themes at each of the domains) before the results were examined to determine which domains should be targeted to reduce imaging.
Nine family doctors (four males; five females) working in community (n = 4) and academic (n = 5) clinics in both rural (n = 6) and urban (n = 3) settings participated in this study. We found five barriers to reducing imaging for patients with NSLBP: 1) negative consequences, 2) patient demand 3) health system organization, 4) time, and 5) access to resources. These were related to the following domains: 1) beliefs about consequences, 2) beliefs about capabilities, 3) emotion, 4) reinforcement, 5) environmental context and resources, 6) social influences, and 7) behavioural regulation.
Family physicians a) fear that if they do not image they may miss something serious, b) face significant patient demand for imaging, c) are working in a system that encourages unnecessary imaging, d) don\'t have enough time to counsel patients about why they don\'t need imaging, and e) lack access to appropriate practitioners, community programs, and treatment modalities to prescribe to their patients. These barriers were related to seven TDF domains. Successfully reducing inappropriate imaging requires a comprehensive intervention that addresses these barriers using established behaviour change techniques. These techniques should be matched directly to relevant TDF domains. The results of our study represent the important first step of this process - identifying the contextual barriers and the domains to which they are related.
摘要：
腰背痛（LBP）是导致残疾的主要原因，也是患者去看家庭医生的五大原因之一。非特异性下腰痛的过度成像仍然是初级保健中的一个问题。为了告知更大的研究，以开发和评估基于理论的干预措施，以减少不适当的成像，我们完成了对纽芬兰和拉布拉多(NL)家庭医生减少NSLBP不必要成像的障碍和促进因素的评估.
这是一次探索,定性研究描述家庭医生与NL非特异性LBP诊断成像相关的经验和做法，以理论域框架(TDF)为指导。数据是使用深入收集的，半结构化面试。在检查结果之前，对转录物进行演绎分析（将文本分配给一个或多个域）和归纳分析（在每个域生成主题），以确定应将哪些域作为目标以减少成像。
在农村（n=6）和城市（n=3）环境中，在社区（n=4）和学术（n=5）诊所工作的9名家庭医生（4名男性；5名女性）参与了这项研究。我们发现了减少NSLBP患者影像学检查的五个障碍：1）负面后果，2）患者需求3）卫生系统组织，4）时间，5)获取资源。这些与以下领域有关：1)关于后果的信念，2）关于能力的信念，3）情感，4)钢筋,5)环境背景和资源，6)社会影响,7)行为调节。
家庭医生a）担心，如果他们不想像自己可能会错过一些严重的事情，b)面对患者对成像的巨大需求，c)在鼓励不必要成像的系统中工作，d）没有足够的时间来咨询患者为什么不需要成像，e)缺乏适当的从业人员，社区项目,以及给病人开处方的治疗方式。这些障碍与七个TDF结构域有关。成功地减少不适当的成像需要使用既定的行为改变技术来解决这些障碍的全面干预。这些技术应该直接匹配相关的TDF域。我们的研究结果代表了这一过程的重要第一步-确定上下文障碍及其相关领域。
这是一次探索,定性研究描述家庭医生与NL非特异性LBP诊断成像相关的经验和做法，以理论域框架(TDF)为指导。数据是使用深入收集的，半结构化面试。在检查结果之前，对转录物进行演绎分析（将文本分配给一个或多个域）和归纳分析（在每个域生成主题），以确定应将哪些域作为目标以减少成像。
在农村（n=6）和城市（n=3）环境中，在社区（n=4）和学术（n=5）诊所工作的9名家庭医生（4名男性；5名女性）参与了这项研究。我们发现了减少NSLBP患者影像学检查的五个障碍：1）负面后果，2）患者需求3）卫生系统组织，4）时间，5)获取资源。这些与以下领域有关：1)关于后果的信念，2）关于能力的信念，3）情感，4)钢筋,5)环境背景和资源，6)社会影响,7)行为调节。
家庭医生a）担心，如果他们不想像自己可能会错过一些严重的事情，b)面对患者对成像的巨大需求，c)在鼓励不必要成像的系统中工作，d）没有足够的时间来咨询患者为什么不需要成像，e)缺乏适当的从业人员，社区项目,以及给病人开处方的治疗方式。这些障碍与七个TDF结构域有关。成功地减少不适当的成像需要使用既定的行为改变技术来解决这些障碍的全面干预。这些技术应该直接匹配相关的TDF域。我们的研究结果代表了这一过程的重要第一步-确定上下文障碍及其相关领域。
