Implementing a clinical practice guideline for acute Low-back pain management in general practice: the IMPLEMENT cluster randomised controlled trial [ACTRN012606000098538].
The recently released NHMRC-endorsed evidence-based clinical practice guideline for acute low-back pain management provides an opportunity to assess the effects of a targeted implementation strategy for use in general medical practice. This trial will assess the effectiveness and cost-effectiveness of an implementation strategy both at the general practitioner and patient level. Successful implementation of these guidelines will reduce the morbidity and cost of acute low-back pain. The trial will contribute to our knowledge about implementation strategies attempting to change clinical practice behaviour.
The IMPLEMENT project is funded by the Australian National Health and Medical Research Council. It is a two stage project with the following aims:
- to identify the barriers and enablers to implementing an evidence-based clinical practice guideline for acute low-back pain in general practice using a theoretical framework;
- to develop a targeted implementation strategy to increase the uptake of the evidence-based clinical practice guideline which addresses the modifiable barriers;
- to test the effectiveness of a strategy for implementing an evidence based clinical practice guideline for acute low back pain in a cluster randomised controlled trial
Stage one consisted of conducting focus groups with general practitioners (GPs) in Victoria underpinned by a theoretical framework grounded in behavioural theory. Multiple barriers to implementing the key messages of the guideline were identified.
Stage two is now underway, and consists of a cluster randomised controlled trial. Ninety two general practices were recruited and randomised to receive either an active implementation strategy or access to the guideline alone. Outcomes will be assessed at the level of the GP (did practice change?) and the patient (did the change result in improved patient outcomes?). We expect the trial will be completed in December 2008.
Professor Sally Green
Dr Denise O’Connor, Ms Joanne McKenzie, A/Prof Neil Spike, A/Prof Peter Schattner, Prof Jeremy Grimshaw, Mr Duncan Mortimer, Mr Simon French, Prof Susan Michie, Dr Jill Francis, A/Prof Rachelle Buchbinder, Dr Peter Kent.
McKenzie J, French S, O'Connor D, Grimshaw J, Mortimer D, Michie S, Francis F, Spike N, Schattner P, Kent P, Buchbinder R & Green S (2008). IMPLEmenting a clinical practice guideline for acute low back pain evidence-based manageMENT in general practice (IMPLEMENT): cluster randomised controlled trial study protocol. Implementation Science 3: 11
Mortimer D, French S, McKenzie J, O'Connor D & Green S (2008). Protocol for economic evaluation alongside the IMPLEMENT cluster randomised controlled trial. Implementation Science 3: 12
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