Introduction of new low back pain guidelines in general practice

Introduction: Knowledge on how to introduce new guidelines effectively in general practice is sparse and earlier studies on guideline implementation have shown modest effect on health care provider behaviour. Implementation strategies that only include few elements could be the reason for unsatisfactory effects. New low back pain (LBP) guidelines are being implemented in the North Denmark Region in 2012/2013. The aim of this study is to evaluate whether an enhanced implementation strategy of the new guidelines will improve LBP treatment.
Methods: A cluster randomized trial will be carried out including one hundred general practices (clusters) randomly allocated to enhanced or usual implementation of the new guidelines. The practices are all situated in the North Denmark Region and count two hundred general practitioners (GPs). The study is designed to include 2,700 patients. Patients aged 18-65 consulting their GP for LBP will be included. Excluded are previously included patients, patients with serious pathology, pregnancy, or not able to fill in Danish questionnaires. General practices in the control group will receive normal guideline implementation and the intervention group will receive an enhanced implementation strategy. Primary outcome is referral rate to spine centres. Assessment of outcomes will be blinded.
Discussion: In this project, behavioural change in General Practice is studied. It will be evaluated whether an enhanced implementation strategy may improve guideline compliance, change treatment course and improve treatment results. Inclusion of patients will take place from the end of 2012 until the end of 2013.