General practitioners' experiences of managing low back pain in primary care in Ireland: A qualitative phenomenological study.

BACKGROUND: Low back pain (LBP) is one of the most common symptoms presented in general practitioner (GP) consultations worldwide and is a leading cause of disability. Despite LBP clinical guidelines advocating for non-pharmacological, primary care-based management, management often diverges from recommendations. OBJECTIVE: The objective of this study was to explore the lived experiences of GPs' management of LBP in primary care, using a qualitative method. METHODS: Twelve GPs across multiple Irish primary care settings were interviewed using a semi-structured guide developed in line with international LBP management guidelines. Interviews were conducted either in-person or via Zoom and audio recorded. The interviews were transcribed and the data were analysed using reflexive thematic analysis. RESULTS: Three key themes were identified. LBP is a common issue with increasing patient complexity. GPs frequently encounter LBP in patients with multimorbidity, particularly in lower socioeconomic settings, complicating diagnosis and management. Secondly, GPs spoke about the complexity of managing LBP. Challenges identified included patient pressure for imaging, limited utility of available imaging, variability in medication prescribing, and patient misunderstandings of physiotherapy. The final theme discussed how the current healthcare system is not fit for purpose. Structural issues such as inequitable access to physiotherapy and the two-tiered public/private healthcare system were cited as major barriers. GPs expressed a need for better resources, education, and support to align care with clinical guidelines. DISCUSSION: The management of LBP in Irish primary care is deeply affected by systemic inequities. Both system-level reform-particularly around equitable access to care-and the development of supportive and accessible resources are needed to empower GPs to successfully manage this significant public health issue.