Clinician education unlikely effective for guideline-adherent medication prescription in low back pain: systematic review and meta-analysis of RCTs

Abstract

Background Effectiveness of implementing interventions to optimise guideline-recommended medical prescription in low back pain is not well established.Methods A systematic review and random-effects meta-analyses for dichotomous outcomes with a Paule-Mandel estimator. Five databases and reference lists were searched from inception to 4 th August 2021. Randomised controlled/clinical trials in adults with low back pain to optimise medication prescription were included. Cochrane Risk of Bias 2 tool and GRADE were implemented. The review was registered prospectively with PROSPERO (CRD42020219767).Findings Of 3352 unique records identified in the search, seven studies were included and five were eligible for metaanalysis (N=11339 participants). Six of seven studies incorporated clinician education, three studies included audit/ feedback components and one study implemented changes in medical records systems. Via meta-analysis, we estimated a non-significant odds-ratio of 0¢94 (95% CI (0¢77; 1.16), I 2 = 0%; n=5 studies, GRADE: low) in favour of the intervention group. The main finding was robust to sensitivity analyses.Interpretation There is low quality evidence that existing interventions to optimise medication prescription or usage in back pain had no impact. Peer-to-peer education alone does not appear to lead to behaviour change. Organisational and policy interventions may be more effective.

Understanding general practitioners’ prescribing choices to patients with chronic low back pain: a discrete choice experiment

“…Clinical decision-making is dynamic and multi-factorial [ 49 , 50 ]. Similar to our main finding, previous research in primary care suggests that patient factors may influence GPs’ decisions less than clinical competence or their knowledge of best practice medicine [ 24 , 50 , 58 – 61 ]. Our results that GPs prefer an NSAID over an opioid is consistent with recent shifts in prescribing data which previously showed increased prescribing of opioid analgesics up until 2017 [ 18 – 20 , 62 , 63 ].…”