Imaging use for low back pain by primary care practitioners

Low back pain is one of the biggest public health problems in Canada. Clinical practice guidelines consistently recommend that diagnostic imaging (for example x-rays, MRI and CT scans) is not performed routinely on people with low back pain because imaging is expensive and offers no help in diagnosing the cause of the pain in most patients with low back pain. In addition, these unnecessary tests lead to wasted resources and even potential harm to people from radiation exposure. It also raises the chances that people will go on to receive further unnecessary tests or treatments, or even invasive and harmful treatments. Despite these guideline recommendations, primary care clinicians frequently ignore these recommendations and order imaging. This project will quantify the extent of unnecessary diagnostic imaging for people with low back pain who visit a primary care practitioner in Ontario, including family physicians, physiotherapists and chiropractors. The project will also explore why these practitioners order diagnostic imaging, and determine whether reasons occur at the patient level, the practitioner level, the system level, or a combination of these. The information gathered will help us develop innovative strategies to reduce unnecessary diagnostic imaging. These strategies could lead to improved use of limited healthcare resources and reduce harm to the substantial number of Canadians who seek care for low back pain.