Barriers to Primary Care Clinician Adherence to Clinical Guidelines for the Management of Low Back Pain

Abstract

Addressing misconceptions and other barriers to uptake of evidence-based guidelines for managing LBP is needed to improve knowledge transfer and close the evidence-practice gap in the treatment of this common condition.

Low back pain and sciatica: summary of NICE guidance

“…It is intended to overcome patchy commissioning of back pain pathways and pain management programmes 6 and poor implementation due to clinicians' beliefs that previous recommendations were constraining clinical practice. 7 Recommendations NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group's experience and opinion of what constitutes good practice.…”

General practice management of rotator cuff related shoulder pain: A reliance on ultrasound and injection guided care

“…There is also a certain level of patient preference for imaging as part of expected care [31,48]. This can be further reinforced by the practitioner's desire to avoid conflict with patients, heavy reliance on past experience together with clinical judgement and what is currently accepted as standard practice among their peers [48]. Our findings could also be explained by a distrust for current guidelines, lack of clarity or difficulty implementing guidelines into practice in relation to imaging of RCRP [31,47,48].…”

“…It is unclear why GPs continue to utilise ultrasound imaging at such a high rate for new RCRP. There may be GP related factors that explain this trend, such as fear of litigation for missing serious pathology, uncertainty regarding clinical (non-imaging) diagnosis and management, or about appropriate care pathways [47,48]. There is also a certain level of patient preference for imaging as part of expected care [31,48].…”

“…There may be GP related factors that explain this trend, such as fear of litigation for missing serious pathology, uncertainty regarding clinical (non-imaging) diagnosis and management, or about appropriate care pathways [47,48]. There is also a certain level of patient preference for imaging as part of expected care [31,48]. This can be further reinforced by the practitioner's desire to avoid conflict with patients, heavy reliance on past experience together with clinical judgement and what is currently accepted as standard practice among their peers [48].…”

“…This can be further reinforced by the practitioner's desire to avoid conflict with patients, heavy reliance on past experience together with clinical judgement and what is currently accepted as standard practice among their peers [48]. Our findings could also be explained by a distrust for current guidelines, lack of clarity or difficulty implementing guidelines into practice in relation to imaging of RCRP [31,47,48]. GPs face many time pressures in their typical day and as such, it is possible that GPs are not aware of the guidelines and have little time to devote to seeking out new or updated guidelines.…”