Sanders T et al. – The authors conclude that the key obstacle to implementation of the new subgrouping for targeted treatment system for low back pain in primary care was an initial failure to achieve 'coherence' of the desired practice change with GPs. Despite this, GPs used the tool to different degrees, though this signified a general commitment to participating in the study rather than a deeper attitude change towards the new system.Methods
- Qualitative interviews were conducted with GPs before (n=32) and after (n=9) the introduction of a subgrouping for targeted treatment system.
- GPs were offered an electronic 6-item subgrouping tool, to identify patients according to their risk of poor outcome ('high', 'low') in order to help inform decision-making about treatment approaches.
- Recruitment was based on a 'maximum diversification sample', to obtain a wide representation of views across all 5 practices.
- A coding scheme was developed based on the emergent findings, and the data were analysed using 'constant comparison', drawing upon insights and developing connections between themes.
- They adopted the 'Normalisation Process Theory' (NPT) to explain the uptake of the new system and to examine the relevance of coherence for the implementation of innovations in organisations.
- GPs perceived back pain as a low clinical priority, and highlighted the importance of 'practical' and 'inter-personal' coherence in decisions to adopt and engage with the new subgrouping for targeted treatment system.
- Health professionals often engage in 'sense making' about new innovations to 'road test' their applicability or relevance to daily clinical routines.
- Low back pain was generally perceived as an 'uninteresting' and clinically unchallenging health problem by GPs, which may partly explain their lack of engagement with the new subgrouping for targeted treatment system.
- The adoption of this new way of working by GPs was determined by the meaning that they ascribed to it in the context of their daily clinical routines.