General Practitioners Views of Implementing a Stratified Treatment Approach for Low Back Pain in Germany: A Qualitative Study

PLoS One. 2015 Aug 31;10(8):e0136119. doi: 10.1371/journal.pone.0136119. eCollection 2015.

Abstract

Background and objective: The STarT Back stratified primary care approach has demonstrated clinical and cost effectiveness in the UK, and is commonly used by General Practitioners (GPs). However, it remains unknown how this approach could be implemented into the German healthcare system. The aim of this study was therefore to explore the views and perceptions of German GPs in respect to using a stratified primary care for low back pain (LBP).

Methods: A 90-minute think-tank workshop was conducted with 14 male and five female GPs, during which the STarT-Back-Screening-Tool (SBST) and related research evidence was presented. This was followed by two focus groups, based on a semi-structured interview guideline to identify potential implementation barriers and opportunities. Discussions were audiotaped, transcribed and coded using a content analysis approach.

Results: For the three deductively developed main themes, 15 subthemes emerged: (1) application of the SBST, with the following subthemes: which health profession should administer it, patients known to the GP practice, the reason for the GP consultation, scoring the tool, the tool format, and the anticipated impact on GP practice; (2) psychologically informed physiotherapy, with subthemes including: provision by a physiotherapist, anticipated impact, the skills of physiotherapists, management of patients with severe psychosocial problems, referral and remuneration; (3) the management of low-risk patients, with subthemes including: concern about the appropriate advising health professional, information and media, length of consultation, and local exercise venues.

Conclusions: The attitudes of GPs towards stratified primary care for LBP indicated positive support for pilot-testing in Germany. However, there were mixed reactions to the ability of German physiotherapists to manage high-risk patients and handle their complex clinical needs. GPs also mentioned practical difficulties in providing extended advice to low-risk patients, which nevertheless could be addressed by involvement of specifically trained medical assistants.

MeSH terms

  • Adult
  • Aged
  • Attitude of Health Personnel*
  • Female
  • Focus Groups
  • General Practitioners / psychology*
  • Germany
  • Humans
  • Low Back Pain / therapy*
  • Male
  • Middle Aged
  • Perception / physiology
  • Physical Therapy Modalities / psychology
  • Physician-Patient Relations
  • Primary Health Care / methods
  • Qualitative Research
  • Referral and Consultation

Grant support

The study was funded by the young scientists programme of the German network 'Health Services Research Baden-Württemberg' (http://www.versorgungsforschung-bw.de) of the Ministry of Science, Research and Arts in collaboration with the Ministry of Employment and Social Order, Family, Women and Senior Citizens, Baden-Württemberg. Study design and preliminary results were discussed at the young scientists academy. We acknowledge financial support by Deutsche Forschungsgemeinschaft (DFG) and Ruprecht-Karls-Universität Heidelberg within the funding programme Open Access Publishing (http://www.ub.uni-heidelberg.de/service/openaccess/publikationsfonds.html). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.