Exploring general practitioner identification and management of psychosocial Yellow Flags in acute low back pain

Cameron Crawford, Kathleen Ryan, Edward Shipton
New Zealand Medical Journal 2007 May 18, 120 (1254): U2536

AIM: Over the past decade, psychosocial issues have been increasingly identified as risk factors that are associated with the development of chronicity and disability. These psychosocial risk factors are known as Yellow Flags. In New Zealand, in 1997, the Accident Compensation Corporation (ACC) published the Acute Low Back Pain Guide and the Guide to Assessing Psychosocial Yellow Flags in Acute Low Back Pain. The aim of this qualitative study is to understand the experiences of general practitioners (GPs) in the identification and management of psychosocial Yellow Flags in patients with acute low back pain.

METHOD: A qualitative research approach was used. GPs were purposively selected and semi-structured interviews were undertaken.

RESULTS: The doctor-patient relationship created the key element for the GPs in approaching any psychosocial factors that were identified. The management of psychosocial factors depended on an individual GP's worldview and orientation to the biopsychosocial model of pain. Problems with time management were composed of multifactorial facets. Funding, lack of appropriate training, and the GPs' perception of ACC's rehabilitation model, all formed components of the meanings that the GPs constructed from their experiences.

CONCLUSION: GPs did not use the Guide to Assessing Psychosocial Yellow Flags in Acute Low Back Pain or the screening questionnaire to identify psychosocial risk factors in their patients with low back pain. Investment of resources in GPs is needed to empower them to be effective gatekeepers guarding against chronicity. This demonstrates a need to alter the current ACC Guideline dissemination and implementation.

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