Family Practice Advance Access originally published online on June 21, 2009
Family Practice 2009 26(5):359-364; doi:10.1093/fampra/cmp042
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GP attitudes and self-reported behaviour in primary care consultations for low back pain
Arthritis Research Campaign National Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK
Correspondence to Mandy Corbett, Arthritis Research Campaign National Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK; E-mail: m.corbett{at}cphc.keele.ac.uk
Received 26 October 2008; Revised 18 May 2009; Accepted 31 May 2009.
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Abstract |
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Background. The implementation of guideline recommendations in primary care has become widespread. The treatment of low back pain (LBP) has followed suite. Research shows that the use of LBP guidelines is influenced by the believability of the underlying evidence, the GPs consultation style and uncertainties surrounding diagnosis and treatment.
Objective. To qualitatively examine the attitudes and self-reported behaviour of GPs in relation to guideline adherence for patients with LBP.
Method. A mixed-method design combining a national UK-based survey of GPs and physiotherapists with an embedded qualitative study. This report focuses only on the GP interviews. We explored GPs’ experience of managing LBP patients and the rationale for treatment offered to a patient described in a written vignette. All interviews were digitally recorded, fully transcribed and analysed using the constant comparative method.
Results. GPs encountered difficulties adhering to guideline recommendations for LBP patients. They experienced particular tensions between recommendations to stay active versus the expectation of being prescribed rest. GPs expressed that chronic LBP often poses an intractable problem requiring specialist advice. The perception that guideline recommendations are ‘imposed’ may create resistance, and the evidence base is not always considered believable.
Conclusions. GPs acknowledge guideline recommendations but divergence occurs in implementation. This is due to GPs focussing on the whole person—not just one condition—and the importance of maintaining the doctor–patient relationship, which relies on effective negotiation of mutual perceptions and expectations. Further exploration on how consultation processes can be constructed to effectively combine evidence with patient-centred care is needed.
Keywords. Doctor–patient relationship, evidence, guideline recommendations, low back pain, qualitative research.
Corbett M, Foster N and Ong BN. GP attitudes and self-reported behaviour in primary care consultations for low back pain. Family Practice 2009; 26: 359–364.