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 .
Shoulder acute pain in primary health care: is retraining GPs effective? The SAPPHIRE randomized trial: a cost-effectiveness analysis.
OBJECTIVES To assess the cost-effectiveness of providing practical training to general practitioners ( GPs ) in shoulder problems , and administering a local anaesthetic ( lignocaine ) vs steroidal ( cortisone ) injection . METHODS A cost-effectiveness analysis conducted alongside a cluster r and omized trial with a factorial design , in general practice s across five centres within the UK . A total of 155 participant GPs were r and omized to receive training or no training with 200 participants r and omized to either lignocaine or cortisone .  Health care costs , quality -adjusted life years ( QALYs ) and incremental cost per QALY gained over 1 year estimated from a health system and a societal perspective were the main outcomes measured . RESULTS Over 1 year , training GPs costs on average an additional pound sterling 211 ( 95 % credibility interval - pound sterling 237 , pound sterling 661 ) than no training and produces higher mean QALYs ( 0.075 ; -0.004 , 0.154 ) per patient , yielding an incremental cost-effectiveness ratio of pound sterling 2813 per QALY gained for trained GPs . Over the same period of 1 year , lignocaine costs an average of pound sterling 122 more ( - pound sterling 232 , pound sterling 476 ) than cortisone and produces virtually no differential gain in mean QALYs ( 0.001 ; -0.068 , 0.070 ) , yielding an incremental cost per QALY gained of pound sterling 122,000 for lignocaine compared with cortisone . Across a range of cost-effectiveness thresholds , cortisone is as cost effective to inject as lignocaine . The probability that training is cost effective is above 0.95 at thresholds above pound sterling 20,000 . CONCLUSIONS Providing practical training to GPs about shoulder problems is cost effective and there is little uncertainty regarding this decision . The choice between lignocaine and cortisone is more uncertain and it is likely that there is significant value of further research to reduce this uncertainty . TRIAL REGISTRATION The International St and ard R and omised Controlled Trial Number is 58 537 244
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 .