Understanding the use of diagnostic imaging for patients with low back pain in the Emergency Department: a qualitative study
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Background: Overuse of lumbar imaging in the Emergency Department is a well-recognised health care challenge. No intervention to date has shown robust reductions in overuse. For an intervention aimed at reducing imaging to be effective, insight into how both patients and clinicians view imaging tests is essential. Aim: The aim for this research is to explore patients’ and clinicians’ views on the use of imaging in the Emergency Department and factors that might influence overuse of imaging. Methods: We recruited participants from three hospitals in Sydney, Australia. We performed focus groups and/or interviews with 14 patients and 12 clinicians. Sessions were audio recorded and transcribed verbatim. We analysed the data using the framework analysis method within a team of four researchers with backgrounds in public health, sociology, musculoskeletal conditions, and low value care. Results: Patients felt that the decision about imaging is made by the ED clinician, and they are not involved in this process. Potential drivers of overuse, from a patient’s perspective, were strong expectations of imaging results, a reluctance to delay of diagnostic imaging, and external parties such as insurance companies requiring imaging. Clinicians stated that patient pressure and the inability to manage this pressure in busy emergency care setting (e.g. lack of time to develop a relationship with patients and to explain the reasons to avoid imaging) could drive overuse. Potential protective factors against overuse of imaging included providing patients with a good explanation and performing a thorough examination, and collaborative approaches to care involving good communication within ED and aligning management with primary care. Conclusion and key findings: We found several factors that could drive overuse of imaging in emergency care setting. Solutions to reduce overuse of imaging in the ED should include: 1) training and support to assist clinicians to provide an adequate and well explained assessment for low back pain, 2) tools to involve patients in decisions about imaging, and 3) care pathways and communication strategies that encourage collaborative approaches to care.