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 .
Evaluation of a complex intervention for changing professional behaviour: the Evidence Based Out Reach (EBOR) Trial
Objectives : To identify the effect of a complex intervention ( educational outreach visits by pharmacists ) design ed to change general practitioners ' ( GPs ' ) prescribing on each step of a hypothesised pathway of change leading to the final primary trial outcome of change in prescribing . Method : The study was undertaken in six health authorities in the North of Engl and and six in London . We described three steps leading to this outcome : the general practice s agreeing to participate ; GPs in each practice attending the outreach visit conducted by the pharmacists ; and the GPs ' prescribing practice being influenced by these visits . The outcomes of each step were assessed using a combination of quantitative and qualitative methods . Results : Of the 102 practice s r and omly selected , 75 ( 73.5 % ) agreed to participate . The odds of all the doctors attending the outreach meeting  in small practice s ( i.e. 1 - 2 partners ) was 6.7 ( 95 % CI : 4.4 - 23.5 ) compared with other practice s ( i.e. > 3 partners ) . Although the pharmacists reported that they had established a good rapport at 100 ( 72 % ) first visits and had agreed management plans for 110 ( 79 % ) of these visits , they were confident that the practice was likely to alter its prescribing in only 41 % of these visits . Pharmacists ' and GPs ' satisfaction with the outreach visits did not necessarily lead to prescribing changes after the practice visit , and the GPs ' knowledge of the guidelines promoted by the pharmacists did not necessarily translate into changes in clinical practice . The main barriers to the implementation of guidelines identified by the pharmacists at the follow-up visits were organisational difficulties , the GPs ' scepticism of the evidence presented to them and the doctors ' lack of interest in changing their prescribing behaviour . Conclusions : Although our study is limited by a post hoc rather than a pre hoc design , it provides a pragmatic approach to underst and ing the factors influencing the pathway of change in prescribing behaviour in response to academic outreach visits
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 .