UNDERSTANDING PHYSICIANS IMAGING TEST USE IN LOW-BACK-PAIN CARE - THEROLE OF FOCUS GROUPS

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.