Using a conceptual framework to study the introduction

Using a conceptual framework to study the introduction of a new approach to the assessment and treatment of low back pain in primary care Stephanie Tooth, Prof Bie Nio Ong & Dr Nadine Foster Arthritis Research Campaign National Primary Care Centre, Keele University, Staffordshire, UK Study Design Background • Low Back Pain is a very common condition (over 1/3 rd adult population affected at any one time) • The economic impact of low back pain is considerable (productivity loss & health care utilisation costs) • Evidence-based clinical practice guidelines for low back pain have been developed • Current clinical practice frequently deviates from the guidelines Qualitative case study • Interview • Observation • Documentary evidence Analysis • NVivo 8 • Constant comparative method (Charmaz) Aim To examine & evaluate the way in which evidence based approaches to assess and manage people with low back pain can be embedded in routine clinical practice in primary care using the Normalization Process Theory (NPT). NPT is used as the conceptual framework to assess the trajectory of the evidence-based approach to the management of low back pain from its introduction to implementation and maintenance. Results Key themes from interviews and observations prior to the implementation of the new approach: • Considerable variation amongst GP’s in their attitude and practice with respect to low back pain • Physiotherapists are eager to enhance their skills with respect to low back pain and believe change is needed in primary care • Low back pain does not appear to be a high priority for GP’s in this study • Decision to refer a patient for physiotherapy is influenced by a complex set of issues relating to the patient, the GP and the system in which they operate. Conclusions Diagrammatic representation of NPT Use of the normalization process theory may not only aid understanding by focusing on the organisational and social processes that help new approaches to become embedded, but may also be useful in shaping future implementation and routine uptake.