title: Implementation barriers for general practice guidelines on low back pain a qualitative study.
abstract: METHODS
  Qualitative study design, using semi-structured interviews.
  
  
  OBJECTIVE
  To explore factors that determine non-adherence to the guidelines for low back pain.
  
  
  BACKGROUND
  Guidelines for low back pain have been published in the past decade in various countries. In the Netherlands, general practitioners adhere to them to a fair extent, and it is unclear whether room for improvement remains.
  
  
  METHODS
  Forty semistructured, in-depth interviews were conducted with twenty patients who consulted for low back pain, and with their general practitioners. The interviews were fully transcribed and analyzed qualitatively.
  
  
  RESULTS
  Patients often had limited expectations of the consultation. They wanted to hear a diagnosis or expected to receive simple advice. The general practitioners said they were well informed about the guideline and mostly agreed with its content. Reasons for non-adherence were mainly related to patients' experiences in the past and general practitioners' interpretations of their preferences. General practitioners stated that they were inclined to give in to patients' demands, for example the request for radiographic films or a referral to a physical therapist. In general, patients and their general practitioners were satisfied with the chosen management.
  
  
  CONCLUSIONS
  Improvement of the quality of back pain care may still be possible. Implementation strategies should aim at training physicians in communication skills, especially about subjects for debate, where patients' beliefs and experiences color their expectations.
authors.affiliation: Centre for Quality of Care Research, University Medical Centre St. Radboud, Nijmegen, The Netherlands. H.Schers@HSV.KUN.NL
authors.forename: H
authors.initials: H
authors.lastname: Schers
authors.forename: M
authors.initials: M
authors.lastname: Wensing
authors.forename: Z
authors.initials: Z
authors.lastname: Huijsmans
authors.forename: M
authors.initials: M
authors.lastname: van Tulder
authors.forename: R
authors.initials: R
authors.lastname: Grol
mesh_terms: D000328:Adult; D000368:Aged; D005194:Family Practice; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D017116:Low Back Pain / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010342:Patient Acceptance of Health Care; D010821:Physicians, Family / Q000523:psychology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards*