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 referrals for lumbar spine radiography: diagnostic yield and clinical guidelines.
BACKGROUND Primary care requests for radiographs of the lumbar spine have come under increasing scrutiny . Guidelines aim ing to reduce unnecessary radiographs by limiting referrals to patients at high risk of serious disease have been widely distributed . Trial evidence suggests that guidelines can reduce radiography referrals . It is not clear whether this reduction has been achieved in routine practice . AIM This study , using routine data , was conducted to measure trends in pnmary care referrals for lumbar spine radiography at two hospitals between 1994 and 1999 . DESIGN OF STUDY Analysis of primary care requests for lumbar spine radiography from computerised records . SETTING Addenbrooke 's Hospital , Cambridge ( 1 July 1994 to 30 June 1999 ) , and Ipswich General Hospital ( 1 July 1995 to 30 June 1999 ) , United Kingdom . METHOD All primary care requests for lumbar radiography were identified electronically from computerised information systems . A r and om sample of 2100 radiography reports were classified according to clinical importance . These classifications were used to examine whether the proportion of radiographs demonstrating potentially more serious findings had increased between 1994 and 1999 . RESULTS There was no evidence that primary care referrals for radiography of the lumbar spine had decreased between 1994 and 1999 at either hospital . General practitioners did not progressively refer more high-risk patients for lumbar radiography . Only a small proportion of patients had important radiographic findings that might warrant specialist referral or specific therapy . CONCLUSION The implementation of diagnostic guidelines offers much to the NHS . However in these two hospitals , the reduction in radiograph utilisation evident in trials was not achieved . Guideline development is a re source intensive process ; distribution must be supported by more effective implementation strategies
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 .