Provider perception of presentations
with nonspecific back pain in the emergency
department and primary care practices:
a semi-structured interview study

Provider perception of presentations
with nonspecific back pain in the emergency
department and primary care practices:
a semi-structured interview study

Health resources, Triage, Health personnel, Emergency Medicine, Interview, Low back Pain, Physician-
patient relations

Abstract
Background Increasing numbers of patients treated in the emergency departments pose challenges to delivering
timely and high-quality care. Particularly, the presentation of patients with low-urgency complaints consumes
resources needed for patients with higher urgency. In this context, patients with non-specific back pain (NSBP) often
present to emergency departments instead of primary care providers. While patient perspectives are well understood,
this study aims to add a provider perspective on the diagnostic and therapeutic approach for NSBP in emergency and
primary care settings.
Methods In a qualitative content analysis, we interviewed seven Emergency Physicians (EP) and nine General
Practitioners (GP) using a semi-structured interview to assess the diagnostic and therapeutic approach to patients
with NSBP in emergency departments and primary care practices. A hypothetical case of NSBP was presented to
the interviewees, followed by questions on their diagnostic and therapeutic approaches. Recruitment was stopped
after reaching saturation of the qualitative content analysis. Reporting this work follows the consolidated criteria for
reporting qualitative research (COREQ) checklist.
Results EPs applied two different strategies for the workup of NSBP. A subset pursued a guideline-compliant
diagnostic approach, ruling out critical conditions and managing pain without extensive diagnostics. Another group
of EPs applied a more extensive approach, including extensive diagnostic resources and specialist consultations. GPs
emphasized physical examinations and stepwise treatment, including scheduled follow-ups and a better knowledge
of the patient history to guide diagnostics and therapy. Both groups attribute ED visits for NSBP to patient related and
healthcare system related factors: lack of understanding of healthcare structures, convenience, demand for immediate
diagnostics, and fear of serious conditions. Furthermore, both groups reported an ill-suited healthcare infrastructure
with insufficiently available primary care services as a contributing factor.

Leo Benning1*, Nora Köhne2

, Hans-Jörg Busch1

and Felix Patricius Hans1

https://doi.org/10.1186/s12245-024-00694-2

2024

Peri Irawan

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