Research article
Acceptance and perceived barriers of implementing a guideline for managing low back in general practice
-
* Corresponding author: Jean-François Chenot jchenot@gwdg.de
1 Dpt. of General Practice, University of Göttingen, Humboldtallee 38, 37073 Goettingen, Germany
2 Dpt. of General Practice, Preventive and Rehabilitation Medicine, University of Marburg, Robert-Koch-Str. 5, 35037 Marburg, Germany
3 Institute for Medical Psychology, University of Marburg, Bunsenstr. 3, 35037 Marburg, Germany
4 Dpt. of Public Health Sciences, University of Hawaii at Manoa, 1960 East-West Rd., Honolulu, HI 96822, USA
5 Dpt. of Anesthesiology, Pain Clinic, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
Implementation Science 2008, 3:7 doi:10.1186/1748-5908-3-7
Published: 7 February 2008Abstract
Background
Implementation of guidelines in clinical practice is difficult. In 2003, the German College of General Practitioners and Family Physicians (DEGAM) released an evidence-based guideline for the management of low back pain (LBP) in primary care. The objective of this study is to explore the acceptance of guideline content and perceived barriers to implementation.
Methods
Seventy-two general practitioners (GPs) participating in quality circles within the framework of an educational intervention study for guideline implementation evaluated the LBP-guideline and its practicability with a standardised questionnaire. In addition, statements of group discussions were recorded using the metaplan technique and were incorporated in the discussion.
Results
Most GPs agree with the guideline content but believe that guideline stipulations are not congruent with patient wishes. Non-adherence to the guideline and contradictory information for patients by other professionals (e.g., GPs, orthopaedic surgeons, physiotherapists) are important barriers to guideline adherence. Almost half of the GPs have no access to recommended multimodal pain programs for patients with chronic LBP.
Conclusion
Promoting adherence to the LBP guideline requires more than enhancing knowledge about evidence-based management of LBP. Public education and an interdisciplinary consensus are important requirements for successful guideline implementation into daily practice. Guideline recommendations need to be adapted to the infrastructure of the health care system.
Trial registration
BMBF Grant Nr. 01EM0113. FORIS (database for research projects in social science) Reg #: 20040116 [25].