Factors affecting general practitioners' decisions about plain radiography for back pain: implications for classification of guideline barriers – a qualitative study

Espeland, Ansgar; Bærheim, Anders

doi:10.1186/1472-6963-3-8

Cited by 102 publications

(131 citation statements)

References 33 publications

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“…This study also found that, given the choice, over 80% of patients would have an x-ray. A review of three qualitative studies involving primary care doctors found that patient preference influenced their decision to order spinal radiography [5]. Patient requests for tests that are not indicated medically can be counteracted by providing information to explain this.…”

Section: Patient-related Factorsmentioning

confidence: 99%

“…Patient preference, either to undergo or not undergo testing or for one test over another, can influence test ordering [3,5,13,17,20,30]. The acceptability of the test to the patient, for example in terms of invasiveness or side effects, and the impact of the potential diagnosis on the patient may affect a doctor's decision to order a test [30].…”

Section: Patient-related Factorsmentioning

confidence: 99%

“…In primary care tests are more commonly used to rule out a condition or to help the doctor to make a decision about referral, or provide further information on the patient to a secondary care specialist [5,20,32]. Another decision that primary care doctors commonly face is whether to order a test or to adopt a period of ''watchful waiting,'' asking a patient to return to see how his or her symptoms develop [39].…”

Section: Diagnostic Factorsmentioning

confidence: 99%

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A review identifies and classifies reasons for ordering diagnostic tests

Whiting¹,

Toerien²,

Salis³

et al. 2007

Journal of Clinical Epidemiology

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Article:Whiting, P., Toerien, M. orcid.org/0000-0003-3159-0931, de Salis, I. et al. (4 more ReuseUnless indicated otherwise, fulltext items are protected by copyright with all rights reserved. The copyright exception in section 29 of the Copyright, Designs and Patents Act 1988 allows the making of a single copy solely for the purpose of non-commercial research or private study within the limits of fair dealing. The publisher or other rights-holder may allow further reproduction and re-use of this version -refer to the White Rose Research Online record for this item. Where records identify the publisher as the copyright holder, users can verify any specific terms of use on the publisher's website. TakedownIf you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing eprints@whiterose.ac.uk including the URL of the record and the reason for the withdrawal request. REVIEW ARTICLESA review identifies and classifies reasons for ordering diagnostic tests Study Design and Setting: We reviewed any study of any design that discussed factors that may affect a doctor's decision to order a test. Articles were located through searches of electronic databases, authors' files on diagnostic methodology, and reference lists of relevant studies. We extracted data on: study design, type of analysis, setting, topic area, and any factors reported to influence test ordering.Results: We included 37 studies. We carried out a thematic analysis to synthesize data. Five key groupings arose from this process: diagnostic factors, therapeutic and prognostic factors, patient-related factors, doctor-related factors, and policy and organization-related factors. To illustrate how the various factors identified may influence test ordering we considered the symptom low back pain and the diagnosis multiple sclerosis as examples.Conclusions: A wide variety of factors influence a doctor's decision to order a test. These are integral to understanding diagnosis in clinical practice. Traditional diagnostic accuracy studies should be supplemented with research into the broader context in which doctors perform their work. Ó

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Section: Patient-related Factorsmentioning

confidence: 99%

Section: Patient-related Factorsmentioning

confidence: 99%

Section: Diagnostic Factorsmentioning

confidence: 99%

See 1 more Smart Citation

A review identifies and classifies reasons for ordering diagnostic tests

Whiting¹,

Toerien²,

Salis³

et al. 2007

Journal of Clinical Epidemiology

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“…It appears that diagnostic procedures differ amongst different cultural settings [21,84]. For example, radiographic procedures for LBP patients and clinical decision making among professionals differ across countries [2,31]. Cross-country differences have also been found to exist in medical, physical and psychosocial findings as well as in the management across LBP sufferers of different cultural backgrounds [15,82,86,98].…”

Section: Introductionmentioning

confidence: 99%

Subclassification of low back pain: a cross-country comparison

2007

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Various health professionals have attempted to classify low back pain (LBP) subgroups and have developed several LBP classification systems. Knowing that culture has an effect on LBP symptomatology, assessment findings and clinical decision making, the aim of this review is to perform a cross-country comparative review amongst the published classification systems, addressing each country's similarities and differences as well as exploring whether cultural factors have been incorporated into the subclassification process. A systematic search of databases limited to human adults was undertaken by Medline, Cinahl, AMED and PEDro databases between January 1980 and October 2005. Classification systems from nine countries were identified. Most studies were classified according to pathoanatomic and/or clinical features, whereas fewer studies utilized a psychosocial and even less, a biopsychosocial approach. Most studies were limited in use to the country of the system's developer. Very few studies addressed cultural issues, highlighting the lack of information on the impact of specific cultural factors on LBP classification procedures. However, there seem to be certain 'cultural trends' in classification systems within each country, which are discussed. Despite the plethora of classification studies, there is still no system which is internationally established, effective, reliable and valid. Future research should aim to develop a LBP classification system within a well identified cultural setting, addressing the multi-dimensional features of the LBP presentation.

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“…They may order imaging for low back pain to appear to be "doing something," or from fear of litigation. [16][17][18][19][20][21] Health system-level factors that may influence these physician behaviors include local practice customs; incentives to follow guidelines (or, conversely, to provide care that patients request); time restraints; and access to automated reminders in the EHR, counseling materials, and radiology services. [19][20][21] The purpose of these analyses was to generate hypotheses for further exploration and development of interventions.…”

Section: Introductionmentioning

confidence: 99%