Background
-
provide over-the-counter (OTC) analgesics and non-steroidal anti-inflammatory drugs (NSAIDs), when it is safe to do so
-
reassure and provide appropriate information and/or advice
-
advise those with "red flags" to seek medical care
-
determine the attitudes, knowledge and reported practice of community pharmacists advising people who present with acute or chronic low back pain
-
compare current reported practice with evidence-based clinical guidelines
-
make recommendations about the pharmacists' role and training needs in relation to self-management of back pain
Methods
Questionnaire design
-
demographic questions about the respondents
-
attitudes towards back pain and its treatment
-
frequency and quality of back pain advice in the pharmacy
-
clinical case studies (2 vignettes)
-
education and training needs
This survey
|
Register England 2004 [17]
|
χ
2
test of proportions
| |||
---|---|---|---|---|---|
Number
|
Percentage
|
Number
|
Percentage
| ||
Age Group
| |||||
29 years and under | 27 | 8.1 | 6855 | 19.6 |
χ
2
= 108.7
|
30 to 39 years | 69 | 20.6 | 9093 | 26.0 |
p < 0.01 |
40 to 49 years | 104 | 31.0 | 7869 | 22.5 | |
50 to 59 years | 92 | 27.5 | 5001 | 14.3 | |
60 to 64 years | 29 | 8.7 | 1609 | 4.6 | |
65 years and over | 14 | 4.2 | 4546 | 13.0 | |
Total | 335 | 100 | 46241 | 100 | |
Sex
| |||||
Male | 120 | 35.9 | 21484 | 46.5 |
χ
2
= 14.8
|
Female | 214 | 64.1 | 24757 | 53.5 |
p < 0.01 |
Total | 334 | 100 | 46241 | 100 | |
Role
|
RPSGB Census 2003 [11]
| ||||
Pharmacy owner | 35 | 10.4 | 3076 | 16.5 |
χ
2
= 52.3
|
Pharmacy manager | 122 | 36.4 | 5214 | 28.0 |
p < 0.01 |
Locum | 153 | 45.7 | 6562 | 35.3 | |
Other employee* | 25 | 7.5 | 3750 | 20.2 | |
Total | 335 | 100 | 18602 | 100 |
Statements (n = 333 unless stated)
|
Number (%) of Respondents
| ||||
---|---|---|---|---|---|
Strongly disagree
|
Strongly agree
| ||||
If you have back pain you should rest until it gets better (n = 332) (WBS) | 75 (22.6) | 119 (35.8) | 82 (24.7) | 50 (15.1) | 6 (1.8) |
If you have back pain you should try and stay active (WBS) | 2 (0.6) | 23 (6.9) | 93 (27.9) | 130 (39.0) | 85 (25.5) |
If you have back pain you should not return to work until free of pain* | 86 (25.8) | 154 (46.2) | 67 (20.1) | 22 (6.6) | 4 (1.2) |
If you have back pain you can use painkillers to control the pain (new) | 2 (0.6) | 3 (0.9) | 40 (12.0) | 167 (50.2) | 121 (36.3) |
Number (%)
| |||
---|---|---|---|
Statement
|
Pain*
|
Agree
|
Disagree
|
I often have negative feelings about advising people with back pain+
| None | 20 (21.5) | 73 (78.5) |
(n = 328) χ2 = 6.4 df = 2 p = 0.040 | Short | 27 (13.8) | 168 (86.2) |
Long | 2 (5.0) | 38 (95.0) | |
Total | 49 (14.9) | 279 (85.1) | |
I most frequently refer people with back pain to their GP | None | 31 (34.1) | 60 (65.9) |
(n = 321) χ2 = 4.7 df = 2 p = 0.094 | Short | 46 (24.1) | 145 (75.9) |
Long | 7 (17.9) | 32 (82.1) | |
Total | 84 (26.2) | 237 (73.8) | |
Back pain is an important topic where I work | None | 23 (25.3) | 68 (74.7) |
(n = 319) χ2 = 17.8 df = 2 p = 0.000 | Short | 68 (36.0) | 121 (64.0) |
Long | 25 (64.1) | 14 (35.9) | |
Total | 116 (36.4) | 203 (63.6) | |
Where I work people often ask for advice about back pain | None | 41 (45.6) | 49 (54.4) |
(n = 323) χ2 = 8.3 df = 2 p = 0.015 | Short | 98 (50.8) | 95 (49.2) |
Long | 29 (72.5) | 11 (27.5) | |
Total | 168 (52.0) | 155 (48.0) | |
I offer good advice about back pain | None | 66 (79.5) | 17 (20.5) |
(n = 304) χ2 = 5.6 df = 2 p = 0.060 | Short | 163 (89.1) | 20 (10.9) |
Long | 35 (92.1) | 3 (7.9) | |
Total | 264 (86.8) | 40 (13.2) | |
My support staff offer good advice about back pain | None | 55 (67.1) | 27 (32.9) |
(n = 298) χ2 = 4.2 df = 2 p = 0.122 | Short | 138 (77.1) | 41 (22.9) |
Long | 24 (64.9) | 13 (35.1) | |
Total | 217 (72.8) | 81 (27.2) |
Number (%)
| |||
---|---|---|---|
Suggestions (n = 315)
|
Pain*
|
Yes
|
No
|
1. Advise her that she must continue to rest? | None | 24 (27.0) | 65 (73.0) |
χ2 = 6.7 df = 2 p = 0.035 | Short | 34 (18.1) | 154 (81.9) |
Long | 3 (7.9) | 35 (92.1) | |
Total | 61 (19.4) | 254 (80.6) | |
2. Suggest adequate analgesia? | None | 85 (95.5) | 4 (4.5) |
χ2 = 2.4 df = 2 p = 0.300 | Short | 177 (94.1) | 11 (5.9) |
Long | 38 (100) | 0 (0) | |
Total | 300 (95.2) | 15 (4.8) | |
3. Tell her to avoid any movement that hurts? | None | 45 (50.6) | 44 (49.4) |
χ2 = 6.5 df = 2 p = 0.040 | Short | 85 (45.2) | 103 (54.8) |
Long | 10 (26.3) | 28 (73.7) | |
Total | 140 (44.4) | 175 (55.6) | |
4. Suggest that swimming or movement in water might be helpful? | None | 59 (66.3) | 30 (33.7) |
χ2 = 9.5 df = 2 p = 0.008 | Short | 142 (75.5) | 46 (24.5) |
Long | 35 (92.1) | 3 (7.9) | |
Total | 236 (74.9) | 79 (25.1) | |
5. Suggest that carrying on with her usual activities as far as possible is the best thing she could do? | None | 43 (48.3) | 46 (51.7) |
χ2 = 0.7 df = 2 p = 0.701 | Short | 99 (52.9) | 88 (47.1) |
Long | 21 (55.3) | 17 (44.7) | |
Total | 163 (51.9) | 151 (48.1) | |
6. Reassure her that back pain affects nearly everyone at some time but usually settles quickly? | None | 30 (33.7) | 59 (66.3) |
χ2 = 11.6 df = 2 p = 0.003 | Short | 102 (54.3) | 86 (45.7) |
Long | 22 (57.9) | 16 (42.1) | |
Total | 154 (48.9) | 161 (51.1) | |
7. Warn her that back pain often gets worse before it gets better? | None | 7 (7.9) | 82 (92.1) |
χ2 = 1.2 df = 2 p = 0.546 | Short | 11 (5.9) | 177 (94.1) |
Long | 4 (10.5) | 34 (89.5) | |
Total | 22 (7.0) | 293 (93.0) |
Number (%)
| ||
---|---|---|
Suggestions (n = 315)
|
Yes
|
No
|
1. Suggest adequate analgesia? | 255 (81.0) | 60 (19.0) |
2. Advise him that he should be careful and avoid doing anything that is painful? | 97 (30.8) | 218 (69.2) |
3. Ask him if he has tried either a cold pack or applying local heat for short term pain relief? | 198 (62.9) | 117 (37.1) |
4. Suggest that movement is good for back pain and regular walks might help? | 215 (68.7) | 100 (31.7) |
5. Warn him that going back to work would be likely to make his back worse? | 13 (4.1) | 301 (95.9) |
6. Suggest that he should try to keep doing his leisure activities? | 192 (61.0) | 123 (39.0) |
7. Suggest that since he still has quite a lot of pain and is finding it difficult to get back to normal activities he might want to consult his GP or a therapist. | 280 (88.9) | 35 (11.1) |