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 .
Primary care clinician adherence to guidelines for the management of chronic musculoskeletal pain: results from the study of the effectiveness of a collaborative approach to pain.
OBJECTIVE We assessed primary care clinician-provided guideline -concordant care as documented in patients ' medical records , predictors of documented guideline -concordant care , and its association with pain-related functioning . Patients were participants in a r and omized trial of collaborative care for chronic musculoskeletal pain . The intervention featured patient and primary care clinician education , symptom monitoring and feedback to clinicians by the intervention team . METHODS To assess concordance with the evidence -based treatment guidelines upon which our intervention was based , we developed an 8-item chart review tool , the  Pain Process Checklist ( PPC ) . We then review ed electronic medical records for 365 veteran patients treated by 42 primary care clinicians over 12 months . Intervention status , demographic , and clinical variables were tested as predictors of PPC scores using generalized estimating equations ( GEE ) . GEE was also used to test whether PPC scores predicted treatment response ( ≥30 % decrease in Rol and -Morris Disability Question naire score ) . RESULTS Rates of documented guideline -concordant care varied widely among PPC items , from 94 % of patients having pain addressed to 17 % of patients on opioids having side effects addressed . Intervention status was unrelated to item scores , and PPC-7 totals did not differ significantly between intervention and treatment-as-usual patients ( 61.2 % , st and ard error [ SE ] = 3.3 % vs 55.2 % , SE = 2.6 % , P = 0.15 ) . In a multivariate model , higher PPC-7 scores were associated with receiving a prescription for opioids ( odds ratio [ OR ] = 1.07 , P = 0.007 ) and lower PPC-7 scores with patient age ( 10-year difference OR = 0.97 , P = 0.004 ) . Finally , intervention patients who received quantitative pain and depression assessment s were less likely to respond to treatment ( assessed vs not : 18 % vs 33 % , P = 0.008 , and 13 % vs 28 % , P = 0.001 , respectively ) . CONCLUSIONS As measured by medical record review , additional training and clinician feedback did not increase provision of documented guideline -concordant pain care , and adherence to guidelines by primary care clinicians did not improve clinical outcomes for patients with chronic musculoskeletal pain
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 .