General Practitioners Views of Implementing a Stratified Treatment Approach for Low Back Pain in Germany: A Qualitative Study

Abstract

Background and ObjectiveThe STarT Back stratified primary care approach has demonstrated clinical and cost effectiveness in the UK, and is commonly used by General Practitioners (GPs). However, it remains unknown how this approach could be implemented into the German healthcare system. The aim of this study was therefore to explore the views and perceptions of German GPs in respect to using a stratified primary care for low back pain (LBP).MethodsA 90-minute think-tank workshop was conducted with 14 male and five female GPs, during which the STarT-Back-Screening-Tool (SBST) and related research evidence was presented. This was followed by two focus groups, based on a semi-structured interview guideline to identify potential implementation barriers and opportunities. Discussions were audiotaped, transcribed and coded using a content analysis approach.ResultsFor the three deductively developed main themes, 15 subthemes emerged: (1) application of the SBST, with the following subthemes: which health profession should administer it, patients known to the GP practice, the reason for the GP consultation, scoring the tool, the tool format, and the anticipated impact on GP practice; (2) psychologically informed physiotherapy, with subthemes including: provision by a physiotherapist, anticipated impact, the skills of physiotherapists, management of patients with severe psychosocial problems, referral and remuneration; (3) the management of low-risk patients, with subthemes including: concern about the appropriate advising health professional, information and media, length of consultation, and local exercise venues.ConclusionsThe attitudes of GPs towards stratified primary care for LBP indicated positive support for pilot-testing in Germany. However, there were mixed reactions to the ability of German physiotherapists to manage high-risk patients and handle their complex clinical needs. GPs also mentioned practical difficulties in providing extended advice to low-risk patients, which nevertheless could be addressed by involvement of specifically trained medical assistants.

Stratified primary care versus non-stratified care for musculoskeletal pain: qualitative findings from the STarT MSK feasibility and pilot cluster randomized controlled trial

“…Findings reported here show both similarities and differences with other qualitative studies into stratified care for MSK pain [32][33][34], including our own earlier paper [19]. In our 2016 paper, some similar barriers were anticipated to those found here, such as difficulty integrating the tool within the consultation time-frame; disruption to the flow of the consultation; and the lack of availability of some matched treatment options.…”

“…In exploring GPs' views on stratified care for LBP in Germany, Karstens et al [33] reported the potential for stratified care to negatively impact upon the therapeutic relationship through undermining GP-patient rapport, a similar finding in our 2016 paper. This partly supports our present finding that patients perceived the closed nature of tool items as hindering the discussion of certain issues, which may indicate some negative impacts on GP-patient communication.…”

Effect of Low Back Pain Risk-Stratification Strategy on Patient Outcomes and Care Processes: the MATCH Randomized Trial in Primary Care

“…has generated great interest in developed countries, providing new hope that meaningful improvements in primary care for LBP are within reach. [14][15][16][17][18][19] Prior to widespread implementation, it would be valuable to know if the STarT Back strategy can be successfully translated to other settings. To determine if the STarT Back risk stratification strategy would succeed in the USA, we conducted the Matching Appropriate Treatments to Consumer Healthcare needs (MATCH) cluster randomized trial.…”

Health practitioners’ perceptions of adopting clinical prediction rules in the management of musculoskeletal pain: a qualitative study in Australia

“… 18 Research findings in primary care settings have similarly identified the need to accommodate diverse practitioner preferences and clinical environments 37 44 and also recommended enabling electronic, phone application and computer-embedded platforms for use. 44 Finally, the desire for guidance on communicating the CPR's results to patients may reduce fear of unintended consequences from CPR use. 18 Provision of a framework that assists communicating unfavourable news to patients 45 and transitions medical information into lay language 46 have been advocated in the past.…”