Table 1.

Performance indicators based on guideline recommendations to measure guideline adherence among GPs [12]

Guideline recommendation	Performance indicator for LBP	Operationalization
A small proportion of patients will not recover with help from the primary care sector, these patients should be referred to secondary care	Referral to consultation with medical specialists (neurology, orthopaedics or other specialty)	Referrals as percentage of total consultations for LBP per GP, reported separately per specialty
Diagnostic imaging is not routinely indicated for acute non-specific LBP; Diagnostic imaging is not recommended for patients with chronic non-specific LBP	Referral for diagnostic imaging	Referrals for MRI, X-ray, CT, Dexa or ultrasound as percentage of total consultations for LBP per GP, reported separately for every imaging technique
Be alert to psychosocial risk factors that can influence the prognosis of LBP, and analyse these if recovery does not occur; Evaluation of psychosocial risk factors that can influence the prognosis of LBP is recommended	Inquiries about psychosocial risk factors	Consultations where psychosocial risk factors were discussed and reported, as percentage of total consultations for LBP per GP
Cognitive behavioural therapy is recommended for patients with cognitive (and) behavioural problems; Patients with LBP that do not recover within 2–3 weeks and have psychosocial risk factors should be referred to a psychologist	Referral for psychosocial care as indicator for multidisciplinary collaboration	Referrals as percentage of total consultations for LBP per GP
In employed patients with LBP a prognosis and recovery expectations for return to work should be discussed	Inquiries about work-related risk factors	Consultations where occupational risk factors were reported as percentage of total consultations for LBP per GP
The general practitioner and the occupational physician should contact each other to coordinate care if the patient’s recovery is stagnating	Referral to and/or contact with occupational physician as indicator for multidisciplinary collaboration*	Consultations where referral to and/or contact with occupational physician was made as percentage of total consultations for LBP per GP, reported separately for referral to and contact between GP and occupational physician

*In the Netherlands, all employers are obligated to ask the advice of an occupational physician in case of a sick-listed employee. The occupational physician has a consultation with an employee when he/she is sick-listed within 6 weeks of the first sick day. The occupational physician will advise both the employee and the employer on what steps need to be taken for a healthy return to work