Table 7 Summary of findings regarding physician-reported barriers to referring for recommended conservative or specialist consultations
TDF Domain | TDF Sub Domain | Specific theme from the study | Studies (participants) | Confidence in the evidence | Explanation |
|---|---|---|---|---|---|
Behaviour: referring to adjunct conservative treatments: physiotherapy or pain management programs | |||||
Knowledge | Knowledge of condition/scientific rationale | GPs unfamiliar with conservative interventions besides medication such as CBT “Most GPs were unfamiliar with the conservative interventions other than medication, such as cognitive-behavioural therapy, spinal manipulations, and exercises.” | 2 (80) | Very low 1,3 | Moderate or serious concerns regarding methodology, coherence and adequacy. |
Scientific rationale | Do not believe that referrals to physical therapy work “It was striking that half of the GPs did not consider physical therapy to be beneficial at all. One said, ‘I think physical therapy is never necessary for this matter.’” | 1 (31) | Very low 5 | Moderate or serious concerns regarding, coherence and adequacy. | |
Environment context and resources | Resources | Lack of services and long wait times for physiotherapy “…structural barriers like lack of access to recommend treatment options prevent guideline-concordant patient management” | 5 (82) | High | No or minor concerns regarding methodology, coherence, adequacy, and relevance. |
Behaviour: referring to specialist services: orthopaedics; surgical consults | |||||
Social influence | Social pressure | Physicians are often pressured to make referrals even if they do not think they are required because solicitors request then for medico-legal patients “Most of these medico-legal patients are referred to us by their solicitors for referral to orthopaedics, I would often tell them to ask their solicitor to do the referral” | 1 (7) | Low2,3 | Moderate or serious concerns regarding methodology, coherence and adequacy. |