{
  "abstract": "Objectives Diagnostic imaging and opioids are considered low-value care for most people with low back pain. To help with this problem, we implemented behaviourally informed interventions aimed at patients and clinicians as part of a large randomised controlled trial NUDG-ED trial. The interventions involved digital posters in patient waiting areas and alerts embedded in clinician electronic health systems. The aim of this qualitative study was to explore emergency department clinician’s experiences of the behavioural interventions for reducing low-value care.Method We conducted 33 interviews of emergency department clinicians with the ability to order imaging or opioids for lower back pain patients. 15 females and 18 males were interviewed ranging from junior to senior physicians, registered nurses and physiotherapists. The interviews were conducted across five hospitals in Sydney that were exposed to either digital posters for patients, clinician electronic health alerts or a combination of these interventions as part of the NUDG-ED trial. We used convenience sampling to recruit participants into one-to-one semi-structured interviews asking questions regarding their experiences on the interventions. We recorded the interviews and transcribed verbatim. We conducted a thematic analysis to identify the main themes from these interviews on how the interventions impacted the care provided to patients with back pain.Results The initial analysis revealed three key themes: i) the value of informative alerts, ii) the importance of patient education and iii) the challenging nature of treating pain in emergency departments. Clinicians found the alerts provided in the clinician ordering software useful. The alerts helped guide decisions, especially in a busy ED environment. The alerts were also succinct and avoided an overload of information. Clinicians emphasised the importance of educating patients about the risks and benefits of tests and treatments in low-risk back pain to reduce low-value care – these elements of the clinician- and patient-facing interventions were valuable. Finally, clinicians highlighted the difficulties of treating back pain in emergency settings and how simple interventions often are limited in their effectiveness in such complex settings.Conclusions The findings from this study highlighted the potential value of embedding patient and clinician alerts in assisting care within the complex and fast-paced environment of emergency departments. These interventions may provide guideline concordant care recommendations at the time of decision making, assisting junior staff by alleviating mental load and facilitating patient conversations about their care. However, the study also identified several limitations to the potential efficacy of these interventions, were challenges such as staff availability, difficulties in managing pain, and language and cultural barriers persist. Factors such as language and cultural barriers may hinder the full potential of patient-focused interventions to improve care in this context.",
  "authors": [
    {
      "affiliations": [
        "Institute for Musculoskeletal Health, Sydney, Australia"
      ],
      "name": "Aidan van Wyk"
    },
    {
      "affiliations": [
        "Institute for Musculoskeletal Health, Sydney, Australia"
      ],
      "name": "Gemma Altinger"
    },
    {
      "affiliations": [
        "Institute for Musculoskeletal Health, Sydney, Australia"
      ],
      "name": "Sweekriti Sharma"
    },
    {
      "affiliations": [
        "Institute for Musculoskeletal Health, Sydney, Australia"
      ],
      "name": "Adrian Traeger"
    }
  ],
  "title": "078 Clinician experiences of behaviourally informed interventions to reduce overdiagnosis and overtreatment of back pain in Australian emergency departments. A qualitative study",
  "uid": "08f3ef01-56a7-5a37-9332-6283ad7b3615"
}