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 .
Influence of postal distribution of the Royal College of Radiologists' guidelines, together with feedback on radiological referral rates, on X-ray referrals from general practice: a randomized controlled trial.
BACKGROUND The Royal College of Radiologists ( RCR ) have produced regularly up date d guidelines on radiological referrals since 1990 . A small study in 1992 showed postal distribution of guidelines reduced general practitioners ' referrals over the subsequent 9 weeks . However there have been no r and omized trials of the longer term effects of radiological guidelines and feedback on referral rates on X-ray requests from primary care . OBJECTIVES To see if the introduction of radiological guidelines into general practice s together with feedback on referral rates reduces the number of GP radiological requests over one year ; and to explore GPs'attitudes to the guidelines . METHODS Sixty-nine practice s referring patients to St George 's Healthcare Trust were r and omly allocated to intervention or control groups . In February 1995 a GP version of the RCR guidelines was sent to each GP in the 33 practice s in the intervention group . After 9 months intervention , practice s were sent revised guidelines with individual feedback on the number of examinations requested in the past 6 months . The total number of requests per practice was compared for the year before and the year after the introduction of the guidelines . Control practice s were sent the guidelines at the end of the study . All doctors were sent a question naire about the guidelines . RESULTS A total of 43 778 radiological requests were made during the two years 1994 - 1996 . In practice s receiving the guidelines there was a 20 % reduction in requests for spinal examinations compared with control practice s ( P < 0.05 ) . This corresponded to the effect reported by GPs . There was also a 10 % difference between the groups in the total number of requests made , but due to wide inter practice variation in referral rates this failed to reach statistical significance . CONCLUSIONS Introduction of radiological guidelines together with feedback on referral rates was effective in reducing the number of requests for spinal examinations over one year . Wider use of GP-orientated guidelines with regular updating and feedback might save costs and reduce unnecessary irradiation of patients
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 .