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document
Randomized controlled trial of education and feedback for implementation of guidelines for acute low back pain . OBJECTIVE The effect of clinical guidelines on resource utilization for complex conditions with substantial barriers to clinician behavior change has not been well studied . We report the impact of a multifaceted guideline implementation intervention on primary care clinician utilization of radiologic and specialty services for the care of acute low back pain . DESIGN Physician groups were randomized to receive guideline education and individual feedback , supporting patient education materials , both , or neither . The impact on guideline adherence and resource utilization was evaluated during the 12-month period before and after implementation . PARTICIPANTS Fourteen physician groups with 120 primary care physician and associate practitioners from 2 group model HMO practices . INTERVENTIONS Guideline implementation utilized an education/audit/feedback model with local peer opinion leaders . The patient education component included written and videotaped materials on the care of low back pain . MAIN RESULTS The clinician intervention was associated with an absolute increase in guideline-consistent behavior of 5.4 % in the intervention group versus a decline of 2.7 % in the control group ( P =.04 ) . The patient education intervention produced no significant change in guideline-consistent behavior , but was poorly adopted . Patient characteristics including duration of pain , prior history of low back pain , and number of visits during the illness episode were strong predictors of service utilization and guideline-consistent behavior . CONCLUSIONS Implementation of an education and feedback-supported acute low back pain care guideline for primary care clinicians was associated with an increase in guideline-consistent behavior . Patient education materials did not enhance guideline effectiveness . Implementation barriers could limit the utility of this approach in usual care settings .
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Intervention_Educational
multifaceted guideline implementation intervention
14902
Intervention_Educational
guideline education and individual feedback , supporting patient education materials , both
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Intervention_Control
neither
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Intervention_Educational
Guideline implementation
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Intervention_Educational
patient education component included written and videotaped materials on the care of low back pain
14906
Intervention_Educational
clinician intervention
14907
Outcome_Mental
guideline-consistent behavior
14908
Outcome_Physical
guideline-consistent behavior
14909
Outcome_Pain
duration of pain
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Outcome_Pain
prior history of low back pain
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Participant_Sample-size
Fourteen
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Participant_Sample-size
120
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Participant_Sample-size
2