Introduction
Low back pain (LBP) is a prevalent musculoskeletal disorder that significantly impacts individuals' quality of life. Despite the availability of various diagnostic and treatment modalities, the overuse of low-value care (LVC) services remains a concern, leading to unnecessary financial burdens on patients and healthcare systems. A recent qualitative study conducted in Iran explored the barriers and facilitators to reducing LVC in LBP management, offering valuable insights for practitioners seeking to improve their skills and patient outcomes.
Understanding the Barriers
The study identified several barriers to reducing LVC in LBP management, categorized into five themes:
- Individual Provider Characteristics: Non-adherence to clinical guidelines, lack of trust among professionals, and defensive medicine were highlighted as significant barriers. Practitioners often face challenges in changing habitual practices and may resort to overtreatment due to fear of missed diagnoses.
- Individual Patient Characteristics: Patient distrust, lack of awareness, and cultural challenges contribute to the demand for unnecessary medical services. Patients' expectations for quick recovery and technology-based interventions further complicate the issue.
- Social Context: A lack of teamwork and inappropriate professional development hinder effective collaboration among healthcare providers. The influence of powerful professional networks and the low socioeconomic status of patients also pose challenges.
- Organizational Context: Inadequate rehabilitation centers, excessive availability of imaging services, and a lack of a comprehensive referral system were identified as organizational barriers. The absence of insurance coverage for certain interventions exacerbates the problem.
- Economic and Political Context: Unrealistic tariffs, legal challenges, and a lack of effective supervision contribute to the persistence of LVC practices.
Leveraging the Facilitators
The study also identified facilitators that can aid in reducing LVC in LBP management:
- Adherence to Clinical Guidelines: Encouraging practitioners to follow evidence-based guidelines can significantly reduce unnecessary interventions.
- Improving the Referral System: Establishing a structured referral system can streamline patient management and ensure appropriate care pathways.
- Enhancing Patient-Provider Relationships: Building trust and effective communication between patients and providers can reduce the demand for unnecessary services.
- Strengthening Teamwork: Promoting inter-professional collaboration can lead to more comprehensive and effective patient care.
- Developing a Desirable Payment Mechanism: Aligning payment structures with high-value care practices can incentivize providers to prioritize patient-centered approaches.
Conclusion
By addressing the identified barriers and leveraging the facilitators, practitioners can enhance their skills and improve patient outcomes in LBP management. The insights from this study provide a roadmap for healthcare providers to reduce LVC and promote evidence-based practices, ultimately benefiting both patients and the healthcare system.
To read the original research paper, please follow this link: Barriers and facilitators to reducing low-value care for the management of low back pain in Iran: a qualitative multi-professional study.
