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Implementation Science

, 8:124

First Online: 20 October 2013Received: 11 July 2013Accepted: 16 October 2013DOI: 10.1186-1748-5908-8-124

Cite this article as: Riis, A., Jensen, C.E., Bro, F. et al. Implementation Sci 2013 8: 124. doi:10.1186-1748-5908-8-124

Abstract

BackgroundEvidence-based clinical practice guidelines may improve treatment quality, but the uptake of guideline recommendations is often incomplete and slow. Recently new low back pain guidelines are being launched in Denmark. The guidelines are considered to reduce personal and public costs. The aim of this study is to evaluate whether a complex, multifaceted implementation strategy of the low back pain guidelines will reduce secondary care referral and improve patient outcomes compared to the usual simple implementation strategy.

Methods-designIn a two-armed cluster randomised trial, 100 general practices clusters and 2,700 patients aged 18 to 65 years from the North Denmark region will be included. Practices are randomly allocated 1:1 to a simple or a complex implementation strategy. Intervention practices will receive a complex implementation strategy, including guideline facilitator visits, stratification tools, and quality reports on low back pain treatment. Primary outcome is referral to secondary care. Secondary outcomes are pain, physical function, health-related quality of life, patient satisfaction with care and treatment outcome, employment status, and sick leave. Primary and secondary outcomes pertain to the patient level. Assessments of outcomes are blinded and follow the intention-to-treat principle. Additionally, a process assessment will evaluate the degree to which the intervention elements will be delivered as planned, as well as measure changes in beliefs and behaviours among general practitioners and patients.

DiscussionThis study provides knowledge concerning the process and effect of an intervention to implement low back pain guidelines in general practice, and will provide insight on essential elements to include in future implementation strategies in general practice.

Trial registrationRegistered as NCT01699256 on ClinicalTrials.gov.

KeywordsGeneral practice Intervention studies Guideline Health plan implementation Low back pain Referral Consultation AbbreviationsCRCTCluster randomised controlled trial

DAK-EDanish quality unit of general practice

DAMDDanish abbreviation for danish general practice database

EQ-5DEuropean quality of life – 5 dimensions

GPGeneral practitioner

ICPCInternational classification for primary care

LBPLow back pain

NordKAPQuality unit for general practice in the North Denmark region

SOSSocial Screening questions

STarTSTarT Back screening tool.

Electronic supplementary materialThe online version of this article doi:10.1186-1748-5908-8-124 contains supplementary material, which is available to authorized users.

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Autor: Allan Riis - Cathrine Elgaard Jensen - Flemming Bro - Helle Terkildsen Maindal - Karin Dam Petersen - Martin Bach Jensen

Fuente: https://link.springer.com/







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