M. Eccles et al., Effect of audit and feedback, and reminder messages on primary-care radiology referrals: a randomised trial, LANCET, 357(9266), 2001, pp. 1406-1409
Citations number
29
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Background Radiological tests are often used by general practitioners (GPs)
. These tests can be overused and contribute little to clinical management.
We aimed to assess two methods of reducing GP requests for radiological te
sts in accordance with the UK Royal College of Radiologists' guidelines on
lumbar spine and knee radiographs, practitioners (GPs), These tests can be
overused contribute little to clinical management.
Methods We assessed audit and feedback, and educational reminder messages i
n six radiology departments and 244 general practices that they served. The
study was a before and-after, pragmatic, cluster randomised controlled tri
al with a 2 x 2 factorial design. A random subset of GP patients' records w
ere examined for concordance with the guidelines. The main outcome measure
was number of radiograph requests per 1000 patients per year. Analysis was
by intention to treat.
Findings The effect of educational reminder messages (ie, the change in req
uest rate after intervention) was an absolute change of -1.53 (95% CI -2.5
to -0.57) for lumbar spine and of -1.61 (-2.6 to -0.62) for knee radiograph
s, both relative reductions of about 28%. The effect of audit and feedback
was an absolute change of -0.07 (-1.3 to 0.9) for lumbar spine of 0.04 (-0.
95 to 1.03) for knee radiograph requests, both relative reductions of about
1%. Concordance between groups did not differ significantly.
Interpretation 6-monthy feedback of audit data is ineffective but the routi
ne attachment of educational reminder messages to radiographs is effective
and does not affect quality of referrals, Any department of radiology that
handles referrals from primary care could deliver this intervention to good
effect.