A web-based clinical decision support tool for primary health care management of back pain: development and mixed methods evaluation.
BACKGROUND
Many patients with back pain do not receive health care in accordance with best practice recommendations. Implementation trials to address this issue have had limited success. Despite the known effectiveness of clinical decision support systems (CDSS), none of these are available for back pain management.


OBJECTIVE
The objective of our study was to develop a Web-based CDSS to support Australian general practitioners (GPs) to diagnose and manage back pain according to guidelines.


METHODS
Asking a panel of international experts to review recommendations for sixteen clinical vignettes validated the tool. It was then launched nationally as part of National Pain Week and promoted to GPs via a media release and clinic based visits. Following this, a mixed methods evaluation was conducted to determine tool feasibility, acceptability, and utility. The 12 month usage data were analyzed, and in-depth, semistructured interviews with 20 GPs were conducted to identify barriers and enablers to uptake.


RESULTS
The tool had acceptable face validity when reviewed by experts. Over a 12 month period there were 7125 website visits with 4503 (63.20%) unique users. Assuming most unique users are GPs, around one quarter of the country's GPs may have used the tool at least once. Although usage was high, GP interviews highlighted the sometimes complex nature of management where the tool may not influence care. Conversely, several "touch-points", whereby the tool may exert its influence, were identified, most notably patient engagement.


CONCLUSIONS
A novel CDSS tool has the potential to assist with evidence-based management of back pain. A clinical trial is required to determine its impact on practitioner and patient outcomes.
The George Institute for Global Health, University of Sydney, Sydney, Australia. dpeiris@georgeinstitute.org.
David
D
Peiris
Christopher
C
Williams
Rachel
R
Holbrook
Robyn
R
Lindner
James
J
Reeve
Anurina
A
Das
Christopher
C
Maher
back pain; clinical decision support systems; primary care