Wim Verstappen
Objective Evaluation of the feasibility of an innovative strategy to improve general practitioners’(GPs’) test ordering behaviour, and to further improve continuous professional development.Design Prospective process evaluation of the use and appraisal of the strategy during the first and second years of a trial.Setting General practice, local GP groups, diagnostic centres.Intervention The new strategy combines written feedback, education on clinical guidelines and continuous quality improvement sessions, quality circles,in small local GP groups. An important feature of the written feedback was a comparison of the behaviour of individual GPs with that of their colleagues. Mutual feedback was given by working in pairs; discussion on national guidelines and making plans for change were important features of the group sessions. The strategy has an iterative character.Results All 194 participating GPs received the planned six feedback reports. Data from 156 meetings of 26 local GP groups showed a participation rate of 81% (95% conŽ dence interval (CI): 77–85%) in the first year and 73% (95% CI: 68–77%) in the second year.Meetings included mutual feedback by working inpairs (used in73%of the sessions in the first year and 61% in the second year), individual plans for change (96% in the first year, 92% in the second year) and group plans for change (71%in the first year, 54% in the second year). In the first year GPs expressed their level of satisfaction with the approach with a score of 7.55 on a scale of 0–10(95% CI:7.46–7.64); average score in the second year was 7.51 (95% CI: 7.30–7.74).Conclusion The innovative test ordering strategy seems a feasible tool for continuous improvement of GPs’ test ordering behaviour, Ž fitting in well with local and regional quality improvement efforts for those GPs working in isolated settings.
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