Understanding physicians' imaging test use in low back pain care: the role of focus groups

Abstract

Our findings suggest that gaining information from focus groups prior to designing physician behavior change interventions may aid the design of more effective interventions.

“It struck me that they didn't understand pain”: The specialist pain clinic experience of patients with chronic musculoskeletal pain

“…The perceived failure of general/family practitioners to take individual's concerns seriously and to provide sufficient time to understand their problem is a recurrent theme in previous studies (25)(26)(27). However, the strength of participants' overall negative feelings about the diagnosis and advice they have received is quite surprising because it is far beyond that identified in previous studies.…”

A review identifies and classifies reasons for ordering diagnostic tests

“…From a diagnostic perspective, tests are ordered to modify the pretest probability of disease [15,29,30,32,33,36],to rule in or rule out disease, or to refer for further evaluation [1,15,29,32,33]. 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].…”

“…However, the results of two studies addressing this issue were contradictory: one found that younger doctors and male doctors tended to order fewer tests [6], whereas the other found that older doctors ordered fewer [26]. Both time pressures [5,30,36] and fear of litigation [5,27,30,37] have been found to result in increased testing. Individual doctors respond differently to patients' requests for unnecessary tests [5,13,17].…”

“…For example in the United Kingdom, the limited availability of diagnostic tests in primary care is an important factor distinguishing it from secondary care, where diagnostic test availability is almost universal. A related factor that influences test ordering is the availability or ease of access to tests [5,22,36,38]. Payment by salaries is associated with lower test ordering than a fee for service approach where doctors are reimbursed for each test performed [6,26,30,34].…”

Low Back Imaging When Not Indicated: A Descriptive Cross-System Analysis

“…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.…”