|
|
Embedding evidence-based approaches in routine primary care – the case of back pain treatment. Stephane Tooth and Pauline Ong, Keele University, UK
Study purpose.
The main study objective is to examine and evaluate the way in which evidence-based approaches to diagnose and manage people with low back pain can be embedded in routine clinical practice in primary care.
The study will place greater emphasis on the theoretical underpinning of implementation approaches than previous studies, by applying the Normalisation Process Theory (Finch and May, in press).We will explore the following:
• the influences of the social and organisational context,
• the way that research knowledge is interpreted and disseminated,
• the division of labour within primary care,
• the way that professionals and patients make sense of the condition and treatments.
The long-term aim is to contribute to the design of future interventions within the implementation field, by offering a more comprehensive approach to explaining how research and decision-making processes are connected, that combines rationalist and scientific with social and contextual approaches.
Design and methods.
This PhD study is embedded within a larger implementation study (IMPaCT Back) and consists of six linked case studies, each representing a GP practice with referral physiotherapy clinic(s). The six practices are situated within Cheshire and cover populations of differing socio-economic and demographic characteristics. The practices range in terms of size (4,000 to 24,000 populations) and composition (four to twelve GPs and a variety of primary care services). Taken together they are representative of English general practice. The practices use various physiotherapy pathways, but again, represent the national picture.
This study will be organised around the four territories outlined above and these define what issues are explored through:
• observations (clinical and management meetings, meetings between researchers and clinicians);
• interviews with clinicians, managers and patients;
• secondary data collection such as notes of meetings, patient case report forms, patient records, patient feedback forms.
• Open-ended responses to questions within practitioner surveys conducted before and after the intervention phase.
The intention is to observe all relevant clinical, management and research meetings and therefore the exact number of observations will remain flexible.
Twenty GPs and 20 physiotherapists are to be recruited for the IMPaCT Back study and a minimum of 50% of these professionals will be interviewed within this PhD study. Furthermore, a number of key PCT managers are involved in facilitating access and implementation, and the intention is to interview all (N= 6). The interviews will be organised around the NPT concepts. We will decide at a later stage whether we will include interviews with patients in order to obtain their perceptions of treatment and outcomes.
For more information about this study contact Prof. Pauline BN Ong (supervisor) or Ms.Stephanie Tooth (PhD student).
b.n.ong@keele.ac.uk
s.tooth@ipchs.keele.ac.uk
|
|