I am the director of a large clinic specializing in the treatment of back pain. I know that the evidence shows that using published clinical practice guidelines for acute low back pain (LBP) gets better patient results. How can I get my staff to follow these more often?

As you point out, clinical practice guidelines (CPGs) for the treatment of acute LBP have been shown effective. Patients treated according to these guidelines get better faster and at a lower cost compared to patients who receive other treatment.

Despite the evidence that supports using these CPGs, less than half of all healthcare providers use them. Understanding why your staff doesn't follow a clearly proven treatment plan is the first step. Since many patients with LBP get better without treatment, your staff may not see the need to follow all the steps in the CPG.

It's important that everyone know what the CPGs say to do. Comparing current practice with the elements of the CPG may be helpful. Find any gaps between these two and develop a plan of action to close the gaps.

You'll need some way to monitor and measure changes in practice. The Department of Defense developed something similar for use in the military healthcare system. You may find some of these materials useful. They can be downloaded from the Internet and printed from www.oqp.med.va.gov/cpg/LBP/LBP_base.htm.