Informing Implementation of a National Integrated Clinical Pathway for Low Back Pain in Ireland: A Pre-Implementation Qualitative Study With General Practitioners

Abstract

Introduction: Ireland's Health Service Executive is developing a new national integrated low back pain (LBP) pathway spanning primary and secondary care to improve LBP healthcare. Clinical pathways are frequently employed to optimise clinical outcomes and resource use but are challenging to implement. Context-specific implementation planning, leveraging implementation science and its conceptual frameworks, should inform successful implementation. Aim: To explore General Practitioner (GP) perceptions of the new LBP pathway, using their on-the-ground knowledge to assess barriers and facilitators to implementation with the goal of developing tailored implementation strategies. Methods: Qualitative data will be collected through semi-structured one-to-one interviews with a purposive sample of GPs. Data analysis will be guided by Framework Analysis with initial open coding followed by mapping to the domains and constructs of the Consolidated Framework for Implementation Science and Proctor's implementation outcomes of acceptability, appropriateness and feasibility. Potential implementation strategies will be devised from the identified determinants of implementation. Conclusion: System-wide changes and improvements in healthcare are difficult to accomplish. The rationale and design of a pre-implementation study with key stakeholders is outlined with the view of informing optimal implementation of Ireland's new national integrated LBP pathway in primary care settings.