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Br J Gen Pract. 1998 Feb; 48(427): 991–997.
PMCID: PMC1409988

Implementing guidelines and innovations in general practice: which interventions are effective?


BACKGROUND: It is crucial that research findings are implemented in general practice if high-quality care is to be achieved. Multifaceted interventions are usually assumed to be more effective than single interventions, but this hypothesis has yet to be tested for general practice care. This review evaluates the effectiveness of interventions in influencing the implementation of guidelines and adoption of innovations in general practice. A systematic literature study was carried out using MEDLINE searches for the period from January 1980 until June 1994, and 21 medical journals were searched manually. Randomized controlled trials and controlled before and after studies (with pre- and post-intervention measurements in all groups) were selected for the analysis. Clinical area, interventions used, methodological characteristics and effects on clinical behaviour were noted independently by two researchers using a standardized scoring form. Of 143 studies found, 61 were selected for the analysis, covering 86 intervention groups that could be compared with a control group without the intervention. Information transfer alone was effective in two out of 18 groups, whereas combinations of information transfer and learning through social influence or management support were effective in four out of eight and three out of seven groups respectively. Information linked to performance was effective in 10 out of 15 groups, but the combination of information transfer and information linked to performance was effective in only three out of 20 groups. Some, but not all, multifaceted interventions are effective in inducing change in general practice. Social influence and management support can improve the effectiveness of information transfer, but information linked to performance does not necessarily do so. The variation in the effectiveness of interventions needs further analysis.

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  • Axt-Adam P, van der Wouden JC, van der Does E. Influencing behavior of physicians ordering laboratory tests: a literature study. Med Care. 1993 Sep;31(9):784–794. [PubMed]
  • Buntinx F, Winkens R, Grol R, Knottnerus JA. Influencing diagnostic and preventive performance in ambulatory care by feedback and reminders. A review. Fam Pract. 1993 Jun;10(2):219–228. [PubMed]
  • Davis DA, Thomson MA, Oxman AD, Haynes RB. Evidence for the effectiveness of CME. A review of 50 randomized controlled trials. JAMA. 1992 Sep 2;268(9):1111–1117. [PubMed]
  • Greco PJ, Eisenberg JM. Changing physicians' practices. N Engl J Med. 1993 Oct 21;329(17):1271–1273. [PubMed]
  • Grilli R, Lomas J. Evaluating the message: the relationship between compliance rate and the subject of a practice guideline. Med Care. 1994 Mar;32(3):202–213. [PubMed]
  • Grimshaw JM, Russell IT. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet. 1993 Nov 27;342(8883):1317–1322. [PubMed]
  • Grimshaw JM, Russell IT. Achieving health gain through clinical guidelines II: Ensuring guidelines change medical practice. Qual Health Care. 1994 Mar;3(1):45–52. [PMC free article] [PubMed]
  • Grimshaw J, Freemantle N, Wallace S, Russell I, Hurwitz B, Watt I, Long A, Sheldon T. Developing and implementing clinical practice guidelines. Qual Health Care. 1995 Mar;4(1):55–64. [PMC free article] [PubMed]
  • Grol R. Implementing guidelines in general practice care. Qual Health Care. 1992 Sep;1(3):184–191. [PMC free article] [PubMed]
  • Johnston ME, Langton KB, Haynes RB, Mathieu A. Effects of computer-based clinical decision support systems on clinician performance and patient outcome. A critical appraisal of research. Ann Intern Med. 1994 Jan 15;120(2):135–142. [PubMed]
  • Mugford M, Banfield P, O'Hanlon M. Effects of feedback of information on clinical practice: a review. BMJ. 1991 Aug 17;303(6799):398–402. [PMC free article] [PubMed]
  • Pommerenke FA, Weed DL. Physician compliance: improving skills in preventive medicine practices. Am Fam Physician. 1991 Feb;43(2):560–568. [PubMed]
  • Robinson MB. Evaluation of medical audit. J Epidemiol Community Health. 1994 Oct;48(5):435–440. [PMC free article] [PubMed]
  • Soumerai SB, McLaughlin TJ, Avorn J. Quality assurance for drug prescribing. Qual Assur Health Care. 1990;2(1):37–58. [PubMed]
  • Wensing M, Grol R. Single and combined strategies for implementing changes in primary care: a literature review. Int J Qual Health Care. 1994 Jun;6(2):115–132. [PubMed]
  • Oxman AD, Clarke MJ, Stewart LA. From science to practice. Meta-analyses using individual patient data are needed. JAMA. 1995 Sep 13;274(10):845–846. [PubMed]
  • Badger LW, Rand EH. Unlearning psychiatry: a cohort effect in the training environment. Int J Psychiatry Med. 1988;18(2):123–135. [PubMed]
  • Buntinx F, Knottnerus JA, Crebolder HF, Seegers T, Essed GG, Schouten H. Does feedback improve the quality of cervical smears? A randomized controlled trial. Br J Gen Pract. 1993 May;43(370):194–198. [PMC free article] [PubMed]
  • Cheney C, Ramsdell JW. Effect of medical records' checklists on implementation of periodic health measures. Am J Med. 1987 Jul;83(1):129–136. [PubMed]
  • Cockburn J, Ruth D, Silagy C, Dobbin M, Reid Y, Scollo M, Naccarella L. Randomised trial of three approaches for marketing smoking cessation programmes to Australian general practitioners. BMJ. 1992 Mar 14;304(6828):691–694. [PMC free article] [PubMed]
  • Cohen DI, Littenberg B, Wetzel C, Neuhauser D. Improving physician compliance with preventive medicine guidelines. Med Care. 1982 Oct;20(10):1040–1045. [PubMed]
  • Cohen SJ, Weinberger M, Hui SL, Tierney WM, McDonald CJ. The impact of reading on physicians' nonadherence to recommended standards of medical care. Soc Sci Med. 1985;21(8):909–914. [PubMed]
  • Curry L, Purkis IE. Validity of self-reports of behavior changes by participants after a CME course. J Med Educ. 1986 Jul;61(7):579–584. [PubMed]
  • Dickinson JC, Warshaw GA, Gehlbach SH, Bobula JA, Muhlbaier LH, Parkerson GR., Jr Improving hypertension control: impact of computer feedback and physician education. Med Care. 1981 Aug;19(8):843–854. [PubMed]
  • Dietrich AJ, O'Connor GT, Keller A, Carney PA, Levy D, Whaley FS. Cancer: improving early detection and prevention. A community practice randomised trial. BMJ. 1992 Mar 14;304(6828):687–691. [PMC free article] [PubMed]
  • Emslie C, Grimshaw J, Templeton A. Do clinical guidelines improve general practice management and referral of infertile couples? BMJ. 1993 Jun 26;306(6894):1728–1731. [PMC free article] [PubMed]
  • Evans CE, Haynes RB, Birkett NJ, Gilbert JR, Taylor DW, Sackett DL, Johnston ME, Hewson SA. Does a mailed continuing education program improve physician performance? Results of a randomized trial in antihypertensive care. JAMA. 1986 Jan 24;255(4):501–504. [PubMed]
  • Gehlbach SH, Wilkinson WE, Hammond WE, Clapp NE, Finn AL, Taylor WJ, Rodell MS. Improving drug prescribing in a primary care practice. Med Care. 1984 Mar;22(3):193–201. [PubMed]
  • Gilio C, Buntinx F, De Kezel O, Scheys I. The influence of a desk-top analyser on the number of laboratory tests used in daily general practice. A randomized controlled trial. Fam Pract. 1993 Jun;10(2):118–123. [PubMed]
  • Hershey CO, Porter DK, Breslau D, Cohen DI. Influence of simple computerized feedback on prescription charges in an ambulatory clinic. A randomized clinical trial. Med Care. 1986 Jun;24(6):472–481. [PubMed]
  • Inui TS, Yourtee EL, Williamson JW. Improved outcomes in hypertension after physician tutorials. A controlled trial. Ann Intern Med. 1976 Jun;84(6):646–651. [PubMed]
  • Jones RH, Lydeard S, Dunleavey J. Problems with implementing guidelines: a randomised controlled trial of consensus management of dyspepsia. Qual Health Care. 1993 Dec;2(4):217–221. [PMC free article] [PubMed]
  • Jennett PA, Laxdal OE, Hayton RC, Klaassen DJ, Swanson RW, Wilson TW, Spooner HJ, Mainprize GW, Wickett RE. The effects of continuing medical education on family doctor performance in office practice: a randomized control study. Med Educ. 1988 Mar;22(2):139–145. [PubMed]
  • Kimberlin CL, Berardo DH, Pendergast JF, McKenzie LC. Effects of an education program for community pharmacists on detecting drug-related problems in elderly patients. Med Care. 1993 May;31(5):451–468. [PubMed]
  • Kottke TE, Brekke ML, Solberg LI, Hughes JR. A randomized trial to increase smoking intervention by physicians. Doctors Helping Smokers, Round I. JAMA. 1989 Apr 14;261(14):2101–2106. [PubMed]
  • Levinson W, Roter D. The effects of two continuing medical education programs on communication skills of practicing primary care physicians. J Gen Intern Med. 1993 Jun;8(6):318–324. [PubMed]
  • Marton KI, Tul V, Sox HC., Jr Modifying test-ordering behavior in the outpatient medical clinic. A controlled trial of two educational interventions. Arch Intern Med. 1985 May;145(5):816–821. [PubMed]
  • McAlister NH, Covvey HD, Tong C, Lee A, Wigle ED. Randomised controlled trial of computer assisted management of hypertension in primary care. Br Med J (Clin Res Ed) 1986 Sep 13;293(6548):670–674. [PMC free article] [PubMed]
  • McDonald CJ, Hui SL, Smith DM, Tierney WM, Cohen SJ, Weinberger M, McCabe GP. Reminders to physicians from an introspective computer medical record. A two-year randomized trial. Ann Intern Med. 1984 Jan;100(1):130–138. [PubMed]
  • McDonald CJ, Wilson GA, McCabe GP., Jr Physician response to computer reminders. JAMA. 1980 Oct 3;244(14):1579–1581. [PubMed]
  • McPhee SJ, Bird JA, Jenkins CN, Fordham D. Promoting cancer screening. A randomized, controlled trial of three interventions. Arch Intern Med. 1989 Aug;149(8):1866–1872. [PubMed]
  • Norton PG, Dempsey LJ. Self-audit: its effect on quality of care. J Fam Pract. 1985 Oct;21(4):289–291. [PubMed]
  • Oakeshott P, Kerry SM, Williams JE. Randomized controlled trial of the effect of the Royal College of Radiologists' guidelines on general practitioners' referrals for radiographic examination. Br J Gen Pract. 1994 May;44(382):197–200. [PMC free article] [PubMed]
  • Ornstein SM, Garr DR, Jenkins RG, Rust PF, Arnon A. Computer-generated physician and patient reminders. Tools to improve population adherence to selected preventive services. J Fam Pract. 1991 Jan;32(1):82–90. [PubMed]
  • Palmer RH, Louis TA, Hsu LN, Peterson HF, Rothrock JK, Strain R, Thompson MS, Wright EA. A randomized controlled trial of quality assurance in sixteen ambulatory care practices. Med Care. 1985 Jun;23(6):751–770. [PubMed]
  • Perera DR, LoGerfo JP, Shulenberger E, Ylvisaker JT, Kirz HL. Teaching sigmoidoscopy to primary care physicians: a controlled study of continuing medical education. J Fam Pract. 1983 Apr;16(4):785–788. [PubMed]
  • Sibley JC, Sackett DL, Neufeld V, Gerrard B, Rudnick KV, Fraser W. A randomized trial of continuing medical education. N Engl J Med. 1982 Mar 4;306(9):511–515. [PubMed]
  • Soumerai SB, Avorn J. Economic and policy analysis of university-based drug "detailing". Med Care. 1986 Apr;24(4):313–331. [PubMed]
  • Stross JK, Bole GG. Evaluation of a continuing education program in rheumatoid arthritis. Arthritis Rheum. 1980 Jul;23(7):846–849. [PubMed]
  • Stross JK, Hiss RG, Watts CM, Davis WK, Macdonald R. Continuing education in pulmonary disease for primary-care physicians. Am Rev Respir Dis. 1983 Jun;127(6):739–746. [PubMed]
  • Szczepura A, Wilmot J, Davies C, Fletcher J. Effectiveness and cost of different strategies for information feedback in general practice. Br J Gen Pract. 1994 Jan;44(378):19–24. [PMC free article] [PubMed]
  • Tierney WM, Hui SL, McDonald CJ. Delayed feedback of physician performance versus immediate reminders to perform preventive care. Effects on physician compliance. Med Care. 1986 Aug;24(8):659–666. [PubMed]
  • Tierney WM, Miller ME, McDonald CJ. The effect on test ordering of informing physicians of the charges for outpatient diagnostic tests. N Engl J Med. 1990 May 24;322(21):1499–1504. [PubMed]
  • White PT, Pharoah CA, Anderson HR, Freeling P. Randomized controlled trial of small group education on the outcome of chronic asthma in general practice. J R Coll Gen Pract. 1989 May;39(322):182–186. [PMC free article] [PubMed]
  • Winickoff RN, Coltin KL, Morgan MM, Buxbaum RC, Barnett GO. Improving physician performance through peer comparison feedback. Med Care. 1984 Jun;22(6):527–534. [PubMed]
  • Berwick DM, Coltin KL. Feedback reduces test use in a health maintenance organization. JAMA. 1986 Mar 21;255(11):1450–1454. [PubMed]
  • Bradlow J, Coulter A. Effect of fundholding and indicative prescribing schemes on general practitioners' prescribing costs. BMJ. 1993 Nov 6;307(6913):1186–1189. [PMC free article] [PubMed]
  • Coulter A, Bradlow J. Effect of NHS reforms on general practitioners' referral patterns. BMJ. 1993 Feb 13;306(6875):433–437. [PMC free article] [PubMed]
  • Fullard E, Fowler G, Gray M. Promoting prevention in primary care: controlled trial of low technology, low cost approach. Br Med J (Clin Res Ed) 1987 Apr 25;294(6579):1080–1082. [PMC free article] [PubMed]
  • Gutiérrez G, Guiscafré H, Bronfman M, Walsh J, Martínez H, Muñoz O. Changing physician prescribing patterns: evaluation of an educational strategy for acute diarrhea in Mexico City. Med Care. 1994 May;32(5):436–446. [PubMed]
  • Harris CM, Fry J, Jarman B, Woodman E. Prescribing--a case for prolonged treatment. J R Coll Gen Pract. 1985 Jun;35(275):284–287. [PMC free article] [PubMed]
  • Klein LE, Charache P, Johannes RS. Effect of physician tutorials on prescribing patterns of graduate physicians. J Med Educ. 1981 Jun;56(6):504–511. [PubMed]
  • Kronsbein P, Jörgens V, Mühlhauser I, Scholz V, Venhaus A, Berger M. Evaluation of a structured treatment and teaching programme on non-insulin-dependent diabetes. Lancet. 1988 Dec 17;2(8625):1407–1411. [PubMed]
  • Lane DS, Polednak AP, Burg MA. Effect of continuing medical education and cost reduction on physician compliance with mammography screening guidelines. J Fam Pract. 1991 Oct;33(4):359–368. [PubMed]
  • Lassen LC, Kristensen FB. Peer comparison feedback to achieve rational and economical drug therapy in general practice: a controlled intervention study. Scand J Prim Health Care. 1992 Mar;10(1):76–80. [PubMed]
  • Payne BC, Lyons TF, Neuhaus E, Kolton M, Dwarshius L. Method of evaluating and improving ambulatory medical care. Health Serv Res. 1984 Jun;19(2):219–245. [PMC free article] [PubMed]
  • Poses RM, Cebul RD, Wigton RS, Centor RM, Collins M, Fleischli G. Controlled trial using computerized feedback to improve physicians' diagnostic judgments. Acad Med. 1992 May;67(5):345–347. [PubMed]
  • Schaffner W, Ray WA, Federspiel CF, Miller WO. Improving antibiotic prescribing in office practice. A controlled trial of three educational methods. JAMA. 1983 Oct 7;250(13):1728–1732. [PubMed]
  • Schectman JM, Elinsky EG, Pawlson LG. Effect of education and feedback on thyroid function testing strategies of primary care clinicians. Arch Intern Med. 1991 Nov;151(11):2163–2166. [PubMed]
  • Tracey JM. Peer review. Part 2: The influence of internal and external standards on outcome. N Z Med J. 1991 Feb 27;104(906):66–67. [PubMed]
  • Verby JE, Holden P, Davis RH. Peer review of consultations in primary care: the use of audiovisual recordings. Br Med J. 1979 Jun 23;1(6179):1686–1688. [PMC free article] [PubMed]
  • Winkens RA, Pop P, Grol RP, Kester AD, Knottnerus JA. Effect of feedback on test ordering behaviour of general practitioners. BMJ. 1992 Apr 25;304(6834):1093–1096. [PMC free article] [PubMed]
  • Zaat JO, van Eijk JT, Bonte HA. Laboratory test form design influences test ordering by general practitioners in The Netherlands. Med Care. 1992 Mar;30(3):189–198. [PubMed]
  • Adams EK. Effect of increased Medicaid fees on physician participation and enrollee service utilization in Tennessee, 1985-1988. Inquiry. 1994 Summer;31(2):173–187. [PubMed]
  • Anderson CM, Chambers S, Clamp M, Dunn IA, McGhee MF, Sumner KR, Wood AM. Can audit improve patient care? Effects of studying use of digoxin in general practice. BMJ. 1988 Jul 9;297(6641):113–114. [PMC free article] [PubMed]
  • Armenian HK, Dajani AW, Fakhro AM. Impact of peer review and itemized records on care in a health center in Bahrain. QRB Qual Rev Bull. 1981 Sep;7(9):6–11. [PubMed]
  • Backe B, Jacobsen G. General practitioners' compliance with guidelines for antenatal care. Scand J Prim Health Care. 1994 Jun;12(2):100–105. [PubMed]
  • Baker D, Klein R, Carter R. Impact of the 1990 contract for general practitioners on night visiting. Br J Gen Pract. 1994 Feb;44(379):68–71. [PMC free article] [PubMed]
  • Barnett GO, Winickoff R, Dorsey JL, Morgan MM, Lurie RS. Quality assurance through automated monitoring and concurrent feedback using a computer-based medical information system. Med Care. 1978 Nov;16(11):962–970. [PubMed]
  • Barnett GO, Winickoff RN, Morgan MM, Zielstorff RD. A computer-based monitoring system for follow-up of elevated blood pressure. Med Care. 1983 Apr;21(4):400–409. [PubMed]
  • Barton MB, Schoenbaum SC. Improving influenza vaccination performance in an HMO setting: the use of computer-generated reminders and peer comparison feedback. Am J Public Health. 1990 May;80(5):534–536. [PMC free article] [PubMed]
  • Bautz JB, Schectman JM, Elinsky EG, Pawlson LG. Magnetic resonance imaging. Diffusion of technology in an ambulatory setting. Int J Technol Assess Health Care. 1992 Spring;8(2):301–308. [PubMed]
  • Bingham RL, Plante DA, Bronson DL, Tufo HM, McKnight K. Establishing a quality improvement process for identification of psychosocial problems in a primary care practice. J Gen Intern Med. 1990 Jul-Aug;5(4):342–346. [PubMed]
  • Bowman MA, Russell NK, Boekeloo BO, Rafi IZ, Rabin DL. The effect of educational preparation on physician performance with a sexually transmitted disease-simulated patient. Arch Intern Med. 1992 Sep;152(9):1823–1828. [PubMed]
  • Brink SG. Provider reminders. Changing information format to increase infant immunizations. Med Care. 1989 Jun;27(6):648–653. [PubMed]
  • Brown RL. Evaluation of a continuing medical education program for primary care physicians on the management of alcoholism. J Med Educ. 1988 Jun;63(6):482–484. [PubMed]
  • Burack RC, Gimotty PA, George J, Stengle W, Warbasse L, Moncrease A. Promoting screening mammography in inner-city settings: a randomized controlled trial of computerized reminders as a component of a program to facilitate mammography. Med Care. 1994 Jun;32(6):609–624. [PubMed]
  • Cauffman JG, Rasgon IM, Mayne JC, Schubert WF, Forsyth RA, Lenoski EF. Relationship between quality of CME instruction and changes in physicians' patient-management plans. J Med Educ. 1985 Jun;60(6):486–488. [PubMed]
  • Cherkin D, Deyo RA, Berg AO, Bergman JJ, Lishner DM. Evaluation of a physician education intervention to improve primary care for low-back pain. I. Impact on physicians. Spine (Phila Pa 1976) 1991 Oct;16(10):1168–1172. [PubMed]
  • Chodroff CH. Cancer screening and immunization quality assurance using a personal computer. QRB Qual Rev Bull. 1990 Aug;16(8):279–287. [PubMed]
  • Creighton PA, Evans AM. Audit of practice based cervical smear programme: completion of the cycle. BMJ. 1992 Apr 11;304(6832):963–966. [PMC free article] [PubMed]
  • Cummings KM, Frisof KB, Long MJ, Hrynkiewich G. The effects of price information on physicians' test-ordering behavior. Ordering of diagnostic tests. Med Care. 1982 Mar;20(3):293–301. [PubMed]
  • Curry RW, Jr, Crandall LA, Coggins WJ. The referral process: a study of one method for improving communication between rural practitioners and consultants. J Fam Pract. 1980 Feb;10(2):287–291. [PubMed]
  • Curtis P, Skinner B, Varenholt JJ, Addison L, Resnick J, Kebede M. Papanicolaou smear quality assurance: providing feedback to physicians. J Fam Pract. 1993 Mar;36(3):309–312. [PubMed]
  • Davidson RA, Fletcher SW, Retchin S, Duh S. A nurse-initiated reminder system for the periodic health examination. Implementation and evaluation. Arch Intern Med. 1984 Nov;144(11):2167–2170. [PubMed]
  • Davies PG, Davies JM. Continuing medical education undertaken by general practitioners using the rural registrar scheme. Med J Aust. 1991 Aug 5;155(3):157–159. [PubMed]
  • Difford F. Reducing prescribing costs through computer controlled repeat prescribing. J R Coll Gen Pract. 1984 Dec;34(269):658–660. [PMC free article] [PubMed]
  • Dowling PT, Alfonsi G, Brown MI, Culpepper L. An education program to reduce unnecessary laboratory tests by residents. Acad Med. 1989 Jul;64(7):410–412. [PubMed]
  • Erramouspe J. Impact of education by clinical pharmacists on physician ambulatory care prescribing of generic versus brand-name drugs. DICP. 1989 Oct;23(10):770–773. [PubMed]
  • Ewart CK, Li VC, Coates TJ. Increasing physicians' antismoking influence by applying an inexpensive feedback technique. J Med Educ. 1983 Jun;58(6):468–473. [PubMed]
  • Fang WL, Mills AS, Wanebo HJ, Zfass AM. The impact of an educational workshop on colorectal screening practices. J Cancer Educ. 1987;2(1):27–30. [PubMed]
  • Ferguson KJ, Caplan RM, Williamson PS. Factors associated with behavior change in family physicians after CME presentation. J Med Educ. 1984 Aug;59(8):662–666. [PubMed]
  • Fleming DM, Lawrence MS. Impact of audit on preventive measures. Br Med J (Clin Res Ed) 1983 Dec 17;287(6408):1852–1854. [PMC free article] [PubMed]
  • Foley EC, D'Amico F, Merenstein JH. Improving mammography recommendation: a nurse-initiated intervention. J Am Board Fam Pract. 1990 Apr-Jun;3(2):87–92. [PubMed]
  • Frame PS, Kowulich BA, Llewellyn AM. Improving physician compliance with a health maintenance protocol. J Fam Pract. 1984 Sep;19(3):341–344. [PubMed]
  • Freeman SW, Chambers CV. Compliance with universal precautions in a medical practice with a high rate of HIV infection. J Am Board Fam Pract. 1992 May-Jun;5(3):313–318. [PubMed]
  • German PS, Shapiro S, Skinner EA, Von Korff M, Klein LE, Turner RW, Teitelbaum ML, Burke J, Burns BJ. Detection and management of mental health problems of older patients by primary care providers. JAMA. 1987 Jan 23;257(4):489–493. [PubMed]
  • Geyman JP, Gordon MJ. Learning outcomes and practice changes after a postgraduate course in office orthopedics. J Fam Pract. 1982 Jul;15(1):131–136. [PubMed]
  • Grant GB, Gregory DA, van Zwanenberg TD. Development of a limited formulary for general practice. Lancet. 1985 May 4;1(8436):1030–1032. [PubMed]
  • Grol R, Mokkink H, Schellevis F. The effects of peer review in general practice. J R Coll Gen Pract. 1988 Jan;38(306):10–13. [PMC free article] [PubMed]
  • Groveman HD, Sanowski RA, Klauber MR. Training primary care physicians in flexible sigmoidoscopy--performance evaluation of 17,167 procedures. West J Med. 1988 Feb;148(2):221–224. [PMC free article] [PubMed]
  • Gruesser M, Bott U, Ellermann P, Kronsbein P, Joergens V. Evaluation of a structured treatment and teaching program for non-insulin-treated type II diabetic outpatients in Germany after the nationwide introduction of reimbursement policy for physicians. Diabetes Care. 1993 Sep;16(9):1268–1275. [PubMed]
  • Gunther PG, Bingham RL. A continuous quality improvement cycle for teaching the identification of psychosocial problems to general internal medicine residents. Acad Med. 1993 Apr;68(4):308–310. [PubMed]
  • Hallas J, Harvald B, Worm J, Beck-Nielsen J, Gram LF, Grodum E, Damsbo N, Schou J, Kromann-Andersen H, Frølund F. Drug related hospital admissions. Results from an intervention program. Eur J Clin Pharmacol. 1993;45(3):199–203. [PubMed]
  • Hamley JG, Brown SV, Crooks J, Knox JD, Murdoch JC, Patterson AW. Prescribing in general practice and the provision of drug information. J R Coll Gen Pract. 1981 Nov;31(232):654–660. [PMC free article] [PubMed]
  • Hemenway D, Killen A, Cashman SB, Parks CL, Bicknell WJ. Physicians' responses to financial incentives. Evidence from a for-profit ambulatory care center. N Engl J Med. 1990 Apr 12;322(15):1059–1063. [PubMed]
  • Ives TJ, Frey JJ, Furr SJ, Bentz EJ. Effect of an educational intervention on oral cephalosporin use in primary care. Arch Intern Med. 1987 Jan;147(1):44–47. [PubMed]
  • Kibbe DC, Bentz E, McLaughlin CP. Continuous quality improvement for continuity of care. J Fam Pract. 1993 Mar;36(3):304–308. [PubMed]
  • Lee DW, Gillis KD. Physician responses to Medicare physician payment reform: preliminary results on access to care. Inquiry. 1993 Winter;30(4):417–428. [PubMed]
  • Madlon-Kay DJ. Improvement in family physician recognition and treatment of hypercholesterolemia. Arch Intern Med. 1989 Aug;149(8):1754–1755. [PubMed]
  • Mandel I, Franks P, Dickinson J. Improving physician compliance with preventive medicine guidelines. J Fam Pract. 1985 Sep;21(3):223–224. [PubMed]
  • Mazze R, Deeb L, Palumbo PJ. Altering physicians' practice patterns--a nationwide educational experiment: evaluation of the Clinical Education Program of the American Diabetes Association. Diabetes Care. 1986 Jul-Aug;9(4):420–425. [PubMed]
  • Mendelson M. Automated reminders do not always improve follow-up of abnormal test results. Comput Biol Med. 1986;16(2):131–134. [PubMed]
  • Nesbitt TS, Davidson RC, Paliescheskey M, Fox-Garcia J, Arevalo JA. Trends in maternity care by graduates and the effect of an intervention. Fam Med. 1994 Mar;26(3):149–153. [PubMed]
  • Palm BT, Kant AC, van den Bosch WJ, Vooijs GP, van Weel C. Preliminary results of a general practice based call system for cervical cancer screening in The Netherlands. Br J Gen Pract. 1993 Dec;43(377):503–506. [PMC free article] [PubMed]
  • Pinkerton RE, Tinanoff N, Willms JL, Tapp JT. Resident physician performance in a continuing education format. Does newly acquired knowledge improve patient care? JAMA. 1980 Nov 14;244(19):2183–2185. [PubMed]
  • Pond CD, Mant A, Kehoe L, Hewitt H, Brodaty H. General practitioner diagnosis of depression and dementia in the elderly: can academic detailing make a difference? Fam Pract. 1994 Jun;11(2):141–147. [PubMed]
  • Rich EC, Schlossberg L, Luxenberg M, Korn J. Influence of a preventive care educational intervention on physician knowledge, attitudes, beliefs, and practice. Prev Med. 1989 Nov;18(6):847–855. [PubMed]
  • Robinson JD. Pharmacokinetics service for ambulatory patients. Am J Hosp Pharm. 1981 Nov;38(11):1713–1716. [PubMed]
  • Rodney WM, Albers G. Flexible sigmoidoscopy: primary care outcomes after two types of continuing medical education. Am J Gastroenterol. 1986 Feb;81(2):133–137. [PubMed]
  • Rodney WM, Beaber RJ, Johnson R, Quan M. Physician compliance with colorectal cancer screening (1978-1983): the impact of flexible sigmoidoscopy. J Fam Pract. 1985 Mar;20(3):265–269. [PubMed]
  • Rodney WM, Chopivsky P, Quan M. Adult immunization: the medical record design as a facilitator for physician compliance. J Med Educ. 1983 Jul;58(7):576–580. [PubMed]
  • Ross AK, Lawton WA. Evaluation of a course for general practitioners on muscles and joints. Br Med J (Clin Res Ed) 1984 Feb 25;288(6417):609–612. [PMC free article] [PubMed]
  • Rosser WW. Using the perception-reality gap to alter prescribing patterns. J Med Educ. 1983 Sep;58(9):728–732. [PubMed]
  • Rosser WW, Palmer WH. Dissemination of guidelines on cholesterol. Effect on patterns of practice of general practitioners and family physicians in Ontario. Ontario Task Force on the Use and Provision of Medical Services. Can Fam Physician. 1993 Feb;39:280–284. [PMC free article] [PubMed]
  • Schaap NP, Houben MH, Driessen WM, van Spreeuwel JP. Endoscopisch onderzoek van de tractus digestivus als service voor de huisarts; ervaringen in de regio Eindhoven. Ned Tijdschr Geneeskd. 1993 Jun 5;137(23):1142–1146. [PubMed]
  • Schectman JM, Elinsky EG, Bartman BA. Primary care clinician compliance with cholesterol treatment guidelines. J Gen Intern Med. 1991 Mar-Apr;6(2):121–125. [PubMed]
  • Shapiro S, German PS, Skinner EA, VonKorff M, Turner RW, Klein LE, Teitelbaum ML, Kramer M, Burke JD, Jr, Burns BJ. An experiment to change detection and management of mental morbidity in primary care. Med Care. 1987 Apr;25(4):327–339. [PubMed]
  • Shaughnessy AF, D'Amico F. Long-term experience with a program to improve prescription-writing skills. Fam Med. 1994 Mar;26(3):168–171. [PubMed]
  • Smith DA, Schnall PL. Improved hypertension control using a surveillance system in a neighborhood health center. Med Care. 1980 Jul;18(7):766–774. [PubMed]
  • Sullivan RJ, Jr, Estes EH, Jr, Stopford W, Lester AJ. Adherence to explicit strategies for common medical conditions. Med Care. 1980 Apr;18(4):388–399. [PubMed]
  • Tierney WM, McDonald CJ, Hui SL, Martin DK. Computer predictions of abnormal test results. Effects on outpatient testing. JAMA. 1988 Feb 26;259(8):1194–1198. [PubMed]
  • Tierney WM, McDonald CJ, Martin DK, Rogers MP. Computerized display of past test results. Effect on outpatient testing. Ann Intern Med. 1987 Oct;107(4):569–574. [PubMed]
  • Tse M, Bridges-Webb C, Bauman A. The impact of a mass communications campaign on the reported management of asthma by general practitioners. Fam Pract. 1993 Sep;10(3):263–267. [PubMed]
  • Varma JR, Schuman BM, Miller MD, Murphy D. The practice outcomes of a course in flexible sigmoidoscopy for primary care physicians. J Med Assoc Ga. 1991 Dec;80(12):711–714. [PubMed]
  • Weingarten MA, Bazel D, Shannon HS. Computerized protocol for preventive medicine: a controlled self-audit in family practice. Fam Pract. 1989 Jun;6(2):120–124. [PubMed]
  • Weisman CS, Morlock LL, Teitelbaum MA, Klassen AC, Celentano DD. Practice changes in response to the malpractice litigation climate. Results of a Maryland physician survey. Med Care. 1989 Jan;27(1):16–24. [PubMed]
  • Whewell PJ, Gore VA, Leach C. Training general practitioners to improve their recognition of emotional disturbance in the consultation. J R Coll Gen Pract. 1988 Jun;38(311):259–262. [PMC free article] [PubMed]
  • Yeo GT, de Burgh SP, Letton T, Shaw J, Donnelly N, Swinburn ME, Phillips S, Bridges-Webb C, Mant A. Educational visiting and hypnosedative prescribing in general practice. Fam Pract. 1994 Mar;11(1):57–61. [PubMed]
  • Zapka JG, Harris DR, Hosmer D, Costanza ME, Mas E, Barth R. Effect of a community health center intervention on breast cancer screening among Hispanic American women. Health Serv Res. 1993 Jun;28(2):223–235. [PMC free article] [PubMed]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners


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