BackgroundDiagnostic imaging has been a part of medicine for the last century. It has been difficult to implement guidelines in this field, and unwarranted imaging has been a frequent problem. Some work has been done to explain these phenomena separately. Identifying the barriers to and facilitators of guideline use has been one strategy. The aim of this study is to offer a more comprehensive explanation of deviations from the guideline by studying the two phenomena together.MethodsEight general practitioners and 10 radiologists from two counties in Norway agreed to semi-structured interviews. Topics covered in the interviews were knowledge of the guideline, barriers to and facilitators of guideline use, implementation of guidelines and factors that influence unwarranted imaging.ResultsSeveral barriers to and facilitators of guideline use were identified. Among these are lack of time, pressure from patients, and guidelines being too long, rigid or unclear. Facilitators of guideline use were easy accessibility and having the guidelines adapted to the target group. Some of the factors that influence unwarranted imaging are lack of time, pressure from patients and availability of imaging services.ConclusionThere are similarities between the perceived barriers for guideline adherence and the perceived factors that influence unwarranted imaging. There may be a few reasons that explains the deviation from guidelines, and the amount of unwarranted imaging.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3372-7) contains supplementary material, which is available to authorized users.

Background There is a high prevalence of musculoskeletal disorders in the Norwegian population. A significant number of these patients are referred to diagnostic imaging. Geographical variations in the use of imaging for musculoskeletal disorders may display over- or underuse, and knowledge about these variations is required. Purpose To investigate geographical variations in diagnostic imaging of the musculoskeletal system and analyze variations in the use of these examinations of all musculoskeletal diagnostic imaging, the specific modalities, and specific examinations. Material and Methods Population rates from Statistics Norway and outpatient radiological procedures of the musculoskeletal system registered at the Norwegian Health Economics Administration (HELFO) the first half of 2016 were accessed. The HELFO data were age-adjusted; high/low ratios were calculated as rates in number of examinations per 1000 inhabitants. A high/low ratio of 1 = equal use, 1.5–1.9 = moderate variation (approximately 50% difference), and > 2 (twice as much) = high variation. Results Geographical variations were demonstrated at all levels, with an overall high/low ratio of 1.3. For specific modalities the highest variation was for ultrasound (3.2) and CT (2.2). For individual examinations, the highest high/low ratios were observed for MRI of the shoulder (2.4) and radiography of the lower back (1.9) and shoulder (1.8). Conclusion We demonstrate a moderate to high geographical variation in the use of diagnostic imaging of the musculoskeletal system. This variation can indicate over- or underuse, which may violate basic principles of equity, priority, setting and appropriate care, and needs further attention.

ObjectiveSignificant geographical variations in the use of diagnostic imaging have been demonstrated in Norway and elsewhere. Non-traumatic musculoskeletal conditions is one area where this has been demonstrated. A national musculoskeletal guideline was implemented in response by online publishing and postal dissemination in Norway in 2014 by national policy makers. The objective of our study was to develop and conduct an intervention as an active re-implementation of this guideline in one Norwegian county to investigate and facilitate guideline adherence. The development and implementation process is reported here, to facilitate understanding of the future evaluation results of this study.ResultsThe consolidated framework for implementation research guided the intervention development and implementation. The implementation development was also based on earlier reported success factors in combination with interviews with general practitioners and radiologists regarding facilitators and barriers to guideline adherence. A combined implementation strategy was developed, including educational meetings, shortening of the guideline and easier access. All the aspects of the implementation strategy were adapted towards general practitioners, radiological personnel and the Norwegian Labor and Welfare Administration. Sixteen educational meetings were held, and six educational videos were made for those unable to attend, or where meetings could not be held.Electronic supplementary materialThe online version of this article (10.1186/s13104-018-3894-4) contains supplementary material, which is available to authorized users.