None listed
Conditions
Brief summary
The aim of this study is to evaluate the effectiveness of feedback for reducing musculoskeletal diagnostic imaging requests in general practice compared with control. A secondary aim is to evaluate which forms of feedback are most effective in reducing musculoskeletal diagnostic imaging requests.
Interventions
Brief name: Feedback on musculoskeletal diagnostic imaging requests
All General Practitioners (GPs) allocated to an intervention group will receive feedback on their diagnostic imaging request rate for 11 musculoskeletal imaging services compared with the request rate of their GP peers. The targeted imaging services are: 1) Low back CT, 2) Low back x-ray, 3) Neck CT, 4) Neck x-ray, 5) Neck MRI, 6) Shoulder x-ray, 7) Shoulder ultrasound, 8) Hip x-ray, 9) Hip ultrasound, 10) Knee x-ray, 11) Ankle
Brief name: Feedback on musculoskeletal diagnostic imaging requests All General Practitioners (GPs) allocated to an intervention group will receive feedback on their diagnostic imaging request rate for 11 musculoskeletal imaging services compared with the request rate of their GP peers. The targeted imaging services are: 1) Low back CT, 2) Low back x-ray, 3) Neck CT, 4) Neck x-ray, 5) Neck MRI, 6) Shoulder x-ray, 7) Shoulder ultrasound, 8) Hip x-ray, 9) Hip ultrasound, 10) Knee x-ray, 11) Ankle/hind foot ultrasound. GPs will be allocated to a control group (Group 1) or one of four intervention groups with feedback as follows: • Group 2: Feedback delivered by mail on one occasion (at month 0) that illustrates (i) in graphical format, the GP’s overall diagnostic imaging request rate per 1000 consultations compared with his/her GP peers over the previous calendar year (January to December 2018), and (ii) in tabular format, the GP’s request rate per 1000 consultations for each musculoskeletal imaging service compared with his/her GP peers over the previous calendar year. • Group 3: Feedback as described in Group 2, but supplemented with highlighted text in the table designed to draw the GP’s attention to those musculoskeletal imaging services where they are in the top 20% of requesters. • Group 4: Feedback as described in Group 2, but supplemented with feedback on a second occasion (at month 9-12) illustrating (i) in graphical format the GPs’ overall diagnostic imaging request rate per 1000 consultations compared with his/her GP peers over the six month period following the first letter and previous calendar year; and (ii) in tabular format, the GP’s request rate per 1000 consultations for each musculoskeletal imaging service compared with his/her GP peers over the six month period following the first letter. • Group 5: Feedback as described in Groups 3 and 4. Purpose of the intervention(s): To reduce musculoskeletal diagnostic imaging requests by high-requesting GPs Procedures: Feedback letter to high-requesting GPs Materials: Feedback letter Provider: Australian Government Department of Health Mode of delivery: Mailed to participants at their nominated mailing address Tailoring: Feedback on musculoskeletal diagnostic imaging request rate individualised to the recipient Fidelity: Return to sender documented
Sponsors
Australian Government Department of Health
Study design
Allocation
Randomised controlled trial
Intervention model
Factorial
Primary purpose
Educational / counselling / training
Masking
Blinded (masking used) (Investigator)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
General practitioners (GPs) practising in Australia, who are in the top 20% of GP requesters for 11 targeted musculoskeletal diagnostic imaging services and in the top 20% of requesters for at least 4 individual items. Targeted diagnostic imaging are: 1) Low back CT, 2) Low back x-ray, 3) Neck CT, 4) Neck x-ray, 5) Neck MRI, 6) Shoulder x-ray, 7) Shoulder ultrasound, 8) Hip x-ray, 9) Hip ultrasound, 10) Knee x-ray, 11) Ankle/hind foot ultrasound. Only diagnostic imaging requests that lead to a service being rendered by a radiologist and for which a Medicare Benefits Schedule (MBS) claim is made are in scope.
Exclusion criteria
1. GPs with <1000 Category 1 services . 2. GPs who did not make any in-scope diagnostic imaging requests within the nominated 12-month period (1 January 2018 to 31 December 2018). 3. GPs who participated in user testing of the intervention 4. GPs who are currently or have been involved in a Department of Health compliance activity within the past 12 months.
Outcome results
None listed