Implementation of a Multidisciplinary Guideline for Low Back Pain: Process-Evaluation Among Health Care Professionals

Abstract

Background To reduce the burden of low back pain (LBP) in the Netherlands, a multidisciplinary guideline for LBP has been implemented in Dutch primary care using a multifaceted implementation strategy targeted at health care professionals (HCPs) and patients. The current paper describes the process evaluation of the implementation among HCPs. Methods The strategy aimed to improve multidisciplinary collaboration and communication, and consisted of 7 components. This process evaluation was performed using the Linnan and Steckler framework. Data were collected using a mixed methods approach of quantitative and qualitative data. Results 128 HCPs participated in the implementation study, of which 96 participated in quantitative and 21 participated in qualitative evaluation. Overall dose delivered for this study was 89 %, and the participants were satisfied with the strategy, mostly with the multidisciplinary approach, which contributed to the mutual understanding of each other’s disciplines and perspectives. While the training sessions did not yield any new information, the strategy created awareness of the guideline and its recommendations, contributing to positively changing attitudes and aiding in improving guideline adherent behaviour. However, many barriers to implementation still exist, including personal and practical factors, confidence, dependence and distrust issues among the HCPs, as well as policy factors (e.g. reimbursement systems). Conclusions The data presented in this paper have shown that the strategy that was used to implement the guideline in a Dutch primary care setting was feasible, especially when using a multidisciplinary approach. However, identified barriers for implementation have been identified and should be addressed in future implementation.

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“…This means that to achieve successful implementation of RTW programs for cancer survivors, first awareness in each system needs to be raised and improved before the next implementation phase can be undertaken. This could, for instance, be achieved in the workplace system by means of management commitment and training/coaching activities for supervisors [19, 32], and in the healthcare and workplace systems simultaneously by means of interactive and multidisciplinary training sessions for healthcare professionals (physicians, specialised nurses, and occupational physicals) to create mutual understanding of each other’s discipline and perspective [33]. Additionally, in the societal system this could be achieved by means of providing information by the national government or the national cancer society or leading cancer charities about the possibilities to work after cancer via a national multimedia campaign, which has been done successfully by the UK charity organisation MacMillan [34].…”

Effectiveness and cost-utility of a multifaceted eHealth strategy to improve back pain beliefs of patients with non-specific low back pain: a cluster randomised trial

“…It is arguable that the participating patients were in good health states from the start and gaining much improvement on these functional outcomes was not realistic. Process evaluations among participating patients and professionals alongside the present study showed that compliance with the intervention was very low 20 21. Most patients did not comply to the full eHealth intervention: 31% of the participants had not used the campaign materials at all, and 42.9% had only used it once, and professionals almost never discussed the intervention with their patients.…”

“…Most patients did not comply to the full eHealth intervention: 31% of the participants had not used the campaign materials at all, and 42.9% had only used it once, and professionals almost never discussed the intervention with their patients. Probably most participants did not need the intervention to improve their functional ability, but improvement in back pain beliefs could have been possible had the compliance rates in this study been higher 20 21…”

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