D. Shye et al., UNDERSTANDING PHYSICIANS IMAGING TEST USE IN LOW-BACK-PAIN CARE - THEROLE OF FOCUS GROUPS, International journal for quality in health care, 10(2), 1998, pp. 83-91
Objective. To gain understanding about why a controlled intervention t
o reduce variability in lumbar spine imaging test use rates for low ba
ck pain patients was ineffective among internal medicine and family pr
actice physicians in a large US health maintenance organization. Desig
n. We retrospectively analyzed data from focus groups that had been co
nducted prior to the implementation of the intervention. The physician
s were asked about the factors that influence their decisions to order
such tests. Study participants. Internal medicine and family practice
physicians in the intervention group. Main study findings. Most of th
e variability in physicians' imaging test ordering appeared to occur i
n the care of patients with back pain of non-traumatic origin who had
no radicular symptoms. Within that clinical context; nonclinical facto
rs such as patient age and work status, time constraints, access probl
ems and ambiguity about internal referral processes were important fac
tors in physicians' decisions. Especially relevant were tensions and c
onflicts the physicians face as they attempted to meet conflicting rol
e obligations in the health maintenance organization. These tensions r
aised issues of patient trust in their physicians and in medical care
organizations, and it appeared that imaging test orders sometimes serv
ed social and symbolic functions in resolving them. Conclusion. Our fi
ndings suggest that gaining information from focus groups prior to des
igning physician behavior change interventions may aid the design of m
ore effective interventions.