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 .
Physician treatment of osteoporosis in response to heel ultrasound bone mineral density reports.
Optimal information that should be included in ultrasound ( US ) heel bone mineral density ( BMD ) reports is not known . If additional information about further evaluation of patients with low heel BMD  were included in reports , would responses for treatment improve ? We screened people at health fairs using the Sahara heel US machine . For those with a T-score of < /= 1.0 , letters were sent to their primary care physician notifying them of the result . Physicians were r and omly assigned to ( 1 ) a st and ard letter , which recommended central bone density screening ( dual X-ray absorptiometry [ DXA ] ) and treatment if the BMD was low ; or ( 2 ) an extended letter , which also outlined treatment strategies based on recommended subsequent central DXA scan results for a T-score of < 1.50 and also if < 2.00 . The extended letter only increased the frequency of DXA testing from 30.1 to 37.2 % ( not a significant increase ) . Of 88 people with heel BMD < /= 1.00 and not previously on any treatment , 25 of 45 ( 56 % ) were treated ( calcium , estrogens , bisphosphonates , or calcitonin or a combination ) after physicians received a st and ard letter and 30 of 43 ( 70 % ) after an extended letter ( one-sided p = 0.084 ) . Of people with T < /= 1.9 , and initially taking nothing more than calcium , 5 of 36 ( 13.9 % ) received additional treatment after physicians received a st and ard letter vs 9 of 41 ( 22.0 % ) after an extended letter ( one-sided p = 0.180 ) . For those with T < /= 1.0 because of the screen 25 of 197 ( 12.7 % ) received additional treatment . One hundred forty-six of 194 ( 75 % ) individuals and received treatment with calcium or other medications , and 74 of 173 ( 43 % ) of individuals before screening and 141 of 195 ( 72 % ) after physicians received letters took calcium . Physicians regarded calcium alone as adequate treatment in many cases . There was no marked increase in treatment when additional information was provided to physicians regarding evaluation and treatment for low US heel BMD results
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 .