A program to reduce imaging for acute low back pain

Abstract

Acute low back pain affects large numbers of people and causes significant morbidity in the community. There is also evidence that general practitioners use imaging as part of the initial assessment of patients who present with low back pain, contrary to guidelines. From 2010 to 2013, NPSMedicineWise ran programs to promote better adherence to guidelines regarding imaging for lowback pain. Initially, the interventions included educational workshops but the mainstay interventions across the entire period were: feedback, including peer comparison; tools to use with the patient in the consultation; and consumer messaging through media. The associated activities of Choosing Wisely Australia provided explicit opinion leader support for the program messages through the involvement of several medical colleges. This program highlights three key elements of program design: • Simple, low-cost interventions can be effective in changing referral behaviour • Knowledge and attitudes of patients must be considered when they are known drivers for the behaviour of interest • Opinion leaders are important especially when there is a standard practice of referral as part of the management pathway. The program described was effective in reducing imaging for lumbar CT scans but could not show a reduction in lumbar X-rays.