Unexplained complaints: those complaints in which the GP, after clarifying the reason for encounter, history taking and performing physical examination cannot establish a diagnosis.
Conditions
Interventions
1. Immediate blood test ordering versus watchful waiting of 4 weeks with blood test ordering after four weeks only if complaints remain
2. Quality improvement strategy consisting of small group meetings, practice visits, patient leaflets and waiting room videotape versus no quality improvement strategy.
Sponsors
a. University of Maastricht, Care and Public Health Research Institute (CAPHRI), Department of General Practice.
PO Box 616
6200 MD Maastricht
The Netherlands
b. Academic Medical Center - University of Amsterdam, Division of Clinical Methods & Public Health, Department of General Practice
J3-370
PO Box 22660
1100 DD Amsterdam
The Netherlands
Eligibility
Inclusion criteria
Inclusion criteria: 1. Patients of 18 years and above with unexplained fatigue; 2. Abdominal complaints; 3. Musculoskeletal complaints; 4. Weight changes or itching who have not contacted their GPs for the last six months with the same complaints and are able to speak, read and write Dutch.
Exclusion criteria
Exclusion criteria: The GP is worried that the patient has got serious pathology that makes watchful waiting unacceptable.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| 1. Accuracy of blood tests for serious pathology (per test and in combinations relevant for general practice), related and in addition to signs and symptoms, at the moment of presentation and after postponing test ordering for four weeks; 2. Adherence of GPs to instruction either to order blood tests directly or after a watchful waiting policy of four weeks. | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. Incidence of unexplained complaints in general practice; 2. Predictive value of GPs working hypothesis; 3. Duration of unexplained complaints; 4. Effect of unexplained complaints on quality of life of patients; 5. Effect of direct testing or watchful waiting on satisfaction with care, anxiety, medical consumption and absence from work of patients; 6. Effect of direct testing or watchful waiting on satisfaction, anxiety and insecurity of GPs; 7. Effect of quality improvement intervention on knowledge about the value of blood test ordering in unexplained complaints, communication skills and attitudes of GPs; 8. Barriers to and facilitators of proposing a watchful waiting strategy by GPs; 9. Costs of the quality improvement intervention. | — |
Contacts
Public ContactG.J. Dinant
University Maastricht (UM), Department of General Practice, P.O. Box 616
Outcome results
None listed