Barrier/enabler | TDF domain | Intervention |
---|---|---|
Imaging for LBP | ||
GPs have a structural/anatomical orientation to LBP and belief that radiological imaging is useful for management | Knowledge | Educational workshops • Include biopsychosocial model of LBP (including HCP and patient beliefs) and epidemiology of LBP and imaging findings |
There is limited knowledge of LBP imaging guidelines | Knowledge | Education workshops • Include LBP Imaging guideline recommendations and use of clinical tools |
GPs are unsure how to advise patients that imaging is not needed | Physical Skills | Education workshops • Include skills rehearsal - patient explanation and advice |
GPs do not believe there are negative consequences of unwarranted imaging | Beliefs about consequences | Education workshops • Include consequences of inappropriate imaging |
There is a perception that patients expect to be investigated with imaging | Social influences | Develop appropriate patient information resource • Information scenarios where imaging is discouraged/not needed |
Having imaging guidelines available will aid memory | Memory, attention & decision processes | Introduce clinical tool – LBP management • Introduce LBP decision making tool that includes imaging recommendations |
Having imaging guidelines accessible are useful | Environmental context & resources | Introduce clinical tool – LBP management • Introduce LBP decision making tool that includes imaging recommendations |
There is a senior GP who is “on board” and a potential opinion leader | Social professional role/identity | Education workshops • Encourage GP leader to ‘have a voice’ during workshops |
Undertake biopsychosocial assessment | ||
There is limited understanding of the biopsychosocial model of LBP | Knowledge | Education workshops • Discuss biopsychosocial model of LBP |
GPs lack skills in undertaking b-p-s assessment | Physical Skills | Education workshops • Include skills rehearsal - questions during b-p-s assessment • Explain use of clinical tools |
There is inadequate time in a GP consult to undertake a b-p-s assessment | Environmental context & resources | Introduce clinical tool – b-p-s screening tool |
Clinical tools can aid assist GPs remember to assess biopsychosocial factors | Memory, attention & decision processes | Introduce clinical tool – b-p-s screening tool |
Provide patient information | ||
Most GPs would like to provide information however there is no patient LBP information available appropriate to the client group | Environmental context & resources | Develop appropriate patient information resource |
Not all GPs know what to advise patients | Knowledge | Education workshops • Patient information • Explain patient information resource |
Overall enablers to facilitating change in LBP care | ||
LBP is seen as a challenging condition to manage and staff are motivated to improve care | Intentions | Education workshops • Acknowledge and reinforce staff motivation to improve care |
There is a culture within the organisation of improving practice | Social professional role/identity | Align program with other quality improvement initiatives |
Educational program that accrue CPD points are valued | Reinforcement | Accredit educational workshops for CPD points with professional organisations. |
The clinic has an integrated patient records system that could host tools to improve practice | Environmental context & resources | Introduce clinical tools that align with integrated patient records system |