title: Acute back pain management in primary care: a qualitative pilot study of the feasibility of a nurse-led service in general practice.
abstract: OBJECTIVE
  (1) To determine the acceptability of the Royal College of General Practitioner Guidelines to small samples of nurses, General Practitioners and acute back pain patients, (2) to determine what additional roles for nurses in the management of acute back pain in primary care might be acceptable to these samples, (3) to evaluate the responses of General Practitioners, nurses and patients to a suggested service model based on the RCGP Guidelines, (4) to identify opportunities for and barriers to the further development of such models and to obtain the appraisal of the above by an external group of assessors.
  
  
  METHODS
  Using a qualitative design the pilot study included Primary Care (General Practitioners, Practice Nurses and Patients) with the main outcome measures as: appraisal questionnaires (for RCGP Guideline), qualitative content analysis of focus group narratives, and appraisal of process and outcomes by an external panel.
  
  
  RESULTS
  Attitudes towards the RCGP guidelines were positive, but professionals and patients alike did not think their recommendations could be implemented with the current service provision in primary care. There was criticism by professionals of the capacity for a nurse-led service within practices. Access to chiropractors, osteopaths and/or specialist physiotherapists in National Health Service primary care was raised as a need by both groups. All members of the Advisory Panel approved the processes for the recruitment of participants, focus group questions and analysis.
  
  
  CONCLUSIONS
  Barriers to implementation of the RCGP Guideline and to a nurse-led acute back pain service in general practice, were illustrated. These mainly relate to grossly inadequate capacity to deal with multidimensional patient needs, allowing progression to chronic pain states and much higher health care costs. There was a strong desire to include a different group of professionals in primary care. We recommend a local needs assessment and consideration of a national strategy for the implementation of the RCGP Guideline in primary care.
authors.affiliation: Institute for Musculoskeletal Research and Clinical Implementation, Anglo-European College of Chiropractic, Bournemouth, UK. imrci@abreen@aecc.ac.uk
authors.forename: Alan
authors.initials: A
authors.lastname: Breen
authors.forename: Eloise
authors.initials: E
authors.lastname: Carr
authors.forename: Eileen
authors.initials: E
authors.lastname: Mann
authors.forename: Holly
authors.initials: H
authors.lastname: Crossen-White
mesh_terms: D000208:Acute Disease; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D001416:Back Pain / Q000451:nursing / Q000523:psychology; D005240:Feasibility Studies; D005260:Female; D017144:Focus Groups; D019983:Guideline Adherence / Q000592:standards; D006801:Humans; D008297:Male; D020380:Needs Assessment; D009722:Nurse Practitioners / Q000458:organization & administration / Q000523:psychology; D024802:Nurse's Role; D015404:Nursing Methodology Research; D010821:Physicians, Family / Q000458:organization & administration / Q000523:psychology; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards*; D015397:Program Evaluation; D036301:Qualitative Research; D013222:State Medicine; D006113:United Kingdom