10 Ideas, concerns and expectations (ICE) in general practice consultations – report of a mixed methods study

Burggraf, Larissa; Stark, Stefanie; Schedlbauer, Angela; Kühlein, Thomas; Roos, Marco

doi:10.1136/bmjebm-2019-pod.24

Cited by 1 publication

(5 citation statements)

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“…Hand-searching of five relevant systematic reviews and citation tracking of included studies identified a further 2 studies. Thus, we identified a total of 38 studies that targeted physician behaviour to reduce unnecessary LBP imaging [ 28 – 65 ]. A description of the study identification and selection process is outlined in the PRISMA flow diagram (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Nineteen (50%) of the studies were conducted in the last 5 years (between 2015-present) in both primary care (82%) [ 30 – 38 , 40 – 42 , 44 – 48 , 50 , 52 – 60 , 62 – 64 ] and emergency settings (18%) [ 28 , 29 , 39 , 43 , 49 , 51 , 61 , 65 ] in the US ( n = 17) [ 28 , 30 , 33 , 35 , 38 , 39 , 41 – 43 , 46 , 47 , 54 , 56 , 59 , 62 , 64 ], the UK ( n = 8) [ 31 , 32 , 40 , 45 , 50 , 53 , 55 , 61 ], Australia ( n = 6) [ 7 , 44 , 48 , 49 , 52 , 58 ], Canada ( n = 3) [ 29 , 34 , 51 ], the Netherlands ( n = 2) [ 60 , 63 ], Finland ( n = 1) [ 57 ] and Germany ( n = 1) [ 65 ]. Study designs included RCTs/Cluster RCTs ( n = 12) [ 31 – 33 , 36 , 45 , 48 , 53 , 55 , 56 , …”

Section: Resultsmentioning

confidence: 99%

“… Schectman 2003 [ 56 ] US x-ray, CT or MRI Cluster RCT No intervention Components: a) Education session (90 min, provided once) b) Patient materials (provided for every LBP patient) c) Audit and feedback (provided twice) d) Written reminders (provided twice) Provider: a) Recognised clinical leaders at each of the respective institutions b) Developed by physicians, a health services researcher, and an expert in patient education materials c) Study team d) Study team Rationale: No Painter: No theory Target provider (setting): ED physicians (hospital setting) Haig 2019 [ 39 ] US CT, MRI UBA No control Components: a) Education (email, provided weekly) b) Questionnaire (ongoing access) c) Order sheet (ongoing access) d) Ongoing access to fast track access to psychiatry and physical therapy Provider: a) Principal investigator at site b) ED triage staff c) ED triage staff d) N/A Rationale: Yes. Previous literature and evidence Painter: No theory Burggraf 2019 [ 65 ] Germany x-ray, MRI, CT Cluster RCT No intervention Components: a) Educational workshop (one day, provided once) b) Ongoing access to online educational materials Provider: a) Study team b) Study team Rationale: Yes. Previous evidence and literature Painter: No theory Machado 2018 [ 49 ] Australia x-ray, MRI, CT Stepped-wedge cluster RCT No intervention (all clusters will ultimately end up with the intervention) Components: a) Education session (40–60 min, provided once with some booster sessions) b) Educational outreach (provided once) b) Audit and feedback (provided monthly) c) Patient resources (provided for every LBP patient) Provider: a) Local opinion leaders b) Clinical educators c) Study team d) The Agency for Clinical Innovation Rationale: Yes.…”

Section: Resultsmentioning

confidence: 99%

“…The remaining 34 studies either i) solely targeted a reduction in imaging, ii) used the same intervention strategy for all of its target behaviours or iii) specified which BCTs targeted LBP imaging behaviour. We identified 18 BCTs across the 34 studies (see Table 3 ); the most common techniques were ‘4.1 instruction on how to perform the behaviour’ ( n = 31 interventions; 26 studies) [ 29 , 32 , 33 , 35 , 36 , 40 – 42 , 44 – 48 , 50 , 52 , 53 , 55 , 57 – 65 ], defined as ‘advise or agree on how to perform the behaviour’, and ‘9.1 credible source’ ( n = 21 interventions; 18 studies) [ 29 , 30 , 32 , 35 , 36 , 40 – 42 , 45 , 46 , 48 , 50 , 53 , 55 , 58 , 59 , 62 , 63 ], defined as ‘present verbal or visual communication from a credible source in favour of or against the behaviour’, ‘7.1 prompts/cues’ ( n = 14 interventions; 14 studies) [ 29 , 30 , 32 , 35 , 41 , 42 , 44 , 46 , 53 , 54 , 57 , 59 , 61 , 64 ] defined as ‘introduce or define environmental or social stimulus with the purpose of prompting or cuing the behaviour’, and ‘2.2 feedback on behaviour’ ( n = 13 interventions; 12 studies) [ 30 , 32 , 33 , 35 , 41 , 45 , 48 , 52 , …”

Section: Resultsmentioning

confidence: 99%

“…Greater than 50% of studies used a BCT that targeted one of the following TDF domains Knowledge ( n = 34 interventions; 27 studies) [ 29 , 32 , 33 , 35 – 37 , 40 – 48 , 50 , 52 , 53 , 55 , 57 – 65 ], Skills ( n = 32 interventions; 27 studies) [ 29 , 31 – 33 , 35 , 36 , 40 – 42 , 44 – 48 , 50 , 52 , 53 , 55 , 57 – 65 ] and Beliefs about capabilities ( n = 32; 27 studies) [ 29 , 31 – 33 , 35 , 36 , 40 – 42 , 44 – 48 , 50 , 52 , 53 , 55 , 57 – 65 ]. Following these, the domains of environmental context and resources ( n = 22 interventions; 21 studies) [ 28 – 30 , 32 , 34 – 36 , 38 , 41 , 44 , 47 , 48 , 51 – 55 , 57 , 59 , 61 , 64 ], social/professional role/identity ( n = 22; 18 studies) [ 29 , 30 , 32 , 35 , …”

Section: Resultsmentioning

confidence: 99%

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What behaviour change techniques have been used to improve adherence to evidence-based low back pain imaging?

et al. 2021

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Background Despite international guideline recommendations, low back pain (LBP) imaging rates have been increasing over the last 20 years. Previous systematic reviews report limited effectiveness of implementation interventions aimed at reducing unnecessary LBP imaging. No previous reviews have analysed these implementation interventions to ascertain what behaviour change techniques (BCTs) have been used in this field. Understanding what techniques have been implemented in this field is an essential first step before exploring intervention effectiveness. Methods We searched EMBASE, Ovid (Medline), CINAHL and Cochrane CENTRAL from inception to February 1, 2021, as well as and hand-searched 6 relevant systematic reviews and conducted citation tracking of included studies. Two authors independently screened titles, abstracts, and full texts for eligibility and extracted data on study and intervention characteristics. Study interventions were qualitatively analysed by three coders to identify BCTs, which were mapped to mechanisms of action from the theoretical domains framework (TDF) using the Theory and Techniques Tool. Results We identified 36 eligible studies from 1984 citations in our electronic search and a further 2 studies from hand-searching resulting in 38 studies that targeted physician behaviour to reduce unnecessary LBP imaging. The studies were conducted in 6 countries in primary (n = 31) or emergency care (n = 7) settings. Thirty-four studies were included in our BCT synthesis which found the most frequently used BCTs were ‘4.1 instruction on how to perform the behaviour’ (e.g. Active/passive guideline dissemination and/or educational seminars/workshops), followed by ‘9.1 credible source’, ‘2.2 feedback on behaviour’ (e.g. electronic feedback reports on physicians’ image ordering) and 7.1 prompts and cues (electronic decision support or hard-copy posters/booklets for the office). This review highlighted that the majority of studies used education and/or feedback on behaviour to target the domains of knowledge and in some cases also skills and beliefs about capabilities to bring about a change in LBP imaging behaviour. Additionally, we found there to be a growing use of electronic or hard copy reminders to target the domains of memory and environmental context and resources. Conclusions This is the first study to identify what BCTs have been used to target a reduction in physician image ordering behaviour. The majority of included studies lacked the use of theory to inform their intervention design and failed to target known physician-reported barriers to following LBP imaging guidelines. Protocol Registation PROSPERO CRD42017072518

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Section: Resultsmentioning

confidence: 99%