The 12 remaining studies across all musculoskeletal conditions showed little or no improvement in GP behaviour and patient outcomes .The direction of the targeted behaviour ( i.e. increasing or decreasing a behaviour ) does not seem to affect the effectiveness of an intervention .
There is good- quality evidence that a GP alerting system with or without patient-directed education on osteoporosis improves guideline -consistent GP behaviour , result ing in better diagnosis and treatment rates .
Interventions such as GP reminder messages and GP feedback on performance combined with guideline dissemination may lead to small improvements in guideline -consistent GP behaviour with regard to low back pain , while GP education on osteoarthritis pain and the use of educationally influential physicians may lead to slight improvement in patient outcomes and guideline -consistent behaviour respectively .
BACKGROUND Musculoskeletal conditions require particular management skills .
Identification of interventions which are effective in equipping general practitioners ( GPs ) with such necessary skills could translate to improved health outcomes for patients and reduced healthcare and societal costs .
OBJECTIVES To determine the effectiveness of professional interventions for GPs  that aim to improve the management of musculoskeletal conditions in primary care .
We investigated whether the direction of the targeted behavioural change affects the effectiveness of interventions .
Can evidence change the rate of back surgery? A randomized trial of community-based education.
CONTEXT Timely adoption of clinical practice guidelines is more likely to happen when the guidelines are used in combination with adjuvant educational strategies that address social as well as rational influences . OBJECTIVE To implement the conservative , evidence -based approach to low-back pain recommended in national guidelines , with the anticipated effect of reducing population -based rates of surgery . DESIGN A r and omized , controlled trial . SETTING Ten communities in western Washington State with annual rates of back surgery above the 1990 national average ( 158 operations per 100,000 adults ) . PARTICIPANTS Spine surgeons , primary care physicians , patients who were surgical c and i date s , and hospital administrators . INTERVENTION The five communities r and omized to the intervention group received a package of six educational activities tailored to local needs by community planning groups . Surgeon study groups , primary care continuing medical education conferences , administrative consensus processes , videodisc-aided patient decision making , surgical outcomes management , and generalist academic detailing were serially implemented over a 30-month intervention period . OUTCOME MEASURE Quarterly observations of surgical rates . RESULTS After implementation of the intervention , surgery rates declined in the intervention communities but increased slightly in the control communities . The net effect of the intervention is estimated to be a decline of 20.9 operations per 100,000 , a relative reduction of 8.9 % ( P = 0.01 ) . CONCLUSION We were able to use scientific evidence to engender voluntary change in back pain practice patterns across entire communities
The 12 remaining studies across all musculoskeletal conditions showed little or no improvement in GP behaviour and patient outcomes .The direction of the targeted behaviour ( i.e. increasing or decreasing a behaviour ) does not seem to affect the effectiveness of an intervention .
There is good- quality evidence that a GP alerting system with or without patient-directed education on osteoporosis improves guideline -consistent GP behaviour , result ing in better diagnosis and treatment rates .
Interventions such as GP reminder messages and GP feedback on performance combined with guideline dissemination may lead to small improvements in guideline -consistent GP behaviour with regard to low back pain , while GP education on osteoarthritis pain and the use of educationally influential physicians may lead to slight improvement in patient outcomes and guideline -consistent behaviour respectively .
BACKGROUND Musculoskeletal conditions require particular management skills .
Identification of interventions which are effective in equipping general practitioners ( GPs ) with such necessary skills could translate to improved health outcomes for patients and reduced healthcare and societal costs .
OBJECTIVES To determine the effectiveness of professional interventions for GPs  that aim to improve the management of musculoskeletal conditions in primary care .
We investigated whether the direction of the targeted behavioural change affects the effectiveness of interventions .