Abstract：
Spine pain is one of the most common conditions seen in primary care and is often treated with ineffective, aggressive interventions, such as prescription pain medications, imagery and referrals to surgery. Aggressive treatments are associated with negative side effects and high costs while conservative care has lower risks and costs and equivalent or better outcomes. Despite multiple well-publicised treatment guidelines and educational efforts recommending conservative care, primary care clinicians (PCCs) widely continue to prescribe aggressive, low-value care for spine pain.
In this qualitative study semistructured interviews were conducted with PCCs treating spine pain patients to learn what prevents clinicians from following guidelines and what tools or support could promote conservative care. Interviews were conducted by telephone, transcribed and coded for thematic analysis.
Forty PCCs in academic and private practice were interviewed. Key reflections included that while familiar with guidelines recommending conservative treatment, they did not find guidelines useful or relevant to care decisions for individual patients. They believed that there is an insufficient body of real-world evidence supporting positive outcomes for conservative care and guidance recommendations. They indicated that spine pain patients frequently request aggressive care. These requests, combined with the PCCs\' commitment to reaching shared treatment decisions with patients, formed a key reason for pursuing aggressive care. PCCs reported not being familiar with risk-screening tools for spine patients but indicated that such screens might increase their confidence to recommend conservative care to low-risk patients.
PCCs may be more willing to give conservative, guideline-consistent care for spine pain if they had tools to assist in making patient-specific evaluations and in countering requests for unneeded aggressive care. Such tools would include both patient risk screens and shared decision-making aids that include elements for resolving patient demands for inappropriate care.
In this qualitative study semistructured interviews were conducted with PCCs treating spine pain patients to learn what prevents clinicians from following guidelines and what tools or support could promote conservative care. Interviews were conducted by telephone, transcribed and coded for thematic analysis.
Forty PCCs in academic and private practice were interviewed. Key reflections included that while familiar with guidelines recommending conservative treatment, they did not find guidelines useful or relevant to care decisions for individual patients. They believed that there is an insufficient body of real-world evidence supporting positive outcomes for conservative care and guidance recommendations. They indicated that spine pain patients frequently request aggressive care. These requests, combined with the PCCs\' commitment to reaching shared treatment decisions with patients, formed a key reason for pursuing aggressive care. PCCs reported not being familiar with risk-screening tools for spine patients but indicated that such screens might increase their confidence to recommend conservative care to low-risk patients.
PCCs may be more willing to give conservative, guideline-consistent care for spine pain if they had tools to assist in making patient-specific evaluations and in countering requests for unneeded aggressive care. Such tools would include both patient risk screens and shared decision-making aids that include elements for resolving patient demands for inappropriate care.
摘要：
脊柱疼痛是初级保健中最常见的疾病之一，通常治疗无效，积极的干预措施，比如处方止痛药，图像和手术转诊。积极治疗与负面副作用和高成本相关，而保守治疗具有较低的风险和成本以及同等或更好的结果。尽管有许多广为人知的治疗指南和建议保守治疗的教育努力，初级保健临床医生(PCC)广泛地继续开出积极的处方，脊柱疼痛的低价值护理。
在这项定性研究中，对治疗脊柱疼痛患者的PCCs进行了半结构化访谈，以了解是什么阻碍了临床医生遵循指南，以及哪些工具或支持可以促进保守治疗。面试是通过电话进行的，转录和编码的主题分析。
采访了40位学术和私人执业专家。主要的思考包括，虽然熟悉推荐保守治疗的指南，他们没有发现指南对个别患者的护理决策有用或相关.他们认为，现实世界的证据不足以支持保守护理和指导建议的积极结果。他们指出，脊柱疼痛患者经常需要积极的护理。这些请求,结合PCCs与患者达成共同治疗决定的承诺，形成了追求侵略性护理的关键原因。PCCs报告不熟悉脊柱患者的风险筛查工具，但表明这种筛查可能会增加他们向低风险患者推荐保守治疗的信心。
PCCs可能更愿意给予保守，脊柱疼痛的指南一致护理，如果他们有工具来帮助进行患者特定的评估和应对不必要的积极护理的要求。这些工具将包括患者风险筛查和共享决策辅助工具，其中包括用于解决患者对不适当护理的需求的元素。
在这项定性研究中，对治疗脊柱疼痛患者的PCCs进行了半结构化访谈，以了解是什么阻碍了临床医生遵循指南，以及哪些工具或支持可以促进保守治疗。面试是通过电话进行的，转录和编码的主题分析。
采访了40位学术和私人执业专家。主要的思考包括，虽然熟悉推荐保守治疗的指南，他们没有发现指南对个别患者的护理决策有用或相关.他们认为，现实世界的证据不足以支持保守护理和指导建议的积极结果。他们指出，脊柱疼痛患者经常需要积极的护理。这些请求,结合PCCs与患者达成共同治疗决定的承诺，形成了追求侵略性护理的关键原因。PCCs报告不熟悉脊柱患者的风险筛查工具，但表明这种筛查可能会增加他们向低风险患者推荐保守治疗的信心。
PCCs可能更愿意给予保守，脊柱疼痛的指南一致护理，如果他们有工具来帮助进行患者特定的评估和应对不必要的积极护理的要求。这些工具将包括患者风险筛查和共享决策辅助工具，其中包括用于解决患者对不适当护理的需求的元素。
