Effect of audit and feedback, and reminder messages on primary-care radiology referrals: a randomised trial
Open accessAbstract
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 tests in accordance with the UK Royal College of Radiologists' guidelines on lumbar spine and knee radiographs. Methods We assessed audit and feedback, and educational reminder messages in six radiology departments and 244 general practices that they served. The study was a before-and-after, pragmatic, cluster randomised controlled trial with a 232 factorial design. A random subset of GP patients' records were 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 request 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 radiographs, both relative reductions of about 20%. 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-monthly feedback of audit data is ineffective but the routine 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.
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Eccles 2001 found that adding reminders to audit and feedback reduced x-ray utilisation (adjusted change relative to baseline control = 46%; no P value reported).
“In a 2x2 factorial trial, Eccles 2001 found that adding reminders to audit and feedback reduced x‐ray utilisation (adjusted change relative to baseline control = 46%; no P value reported).”
From Audit and feedback: effects on professional practice and healthcare outcomes (2012) · cites this paper as Eccles 2001
Cites
Fundamentals of Biostatistics.
(1969) · Annals of Internal Medicine · doi:10.7326/0003-4819-70-4-873 · Cited by 4,573 · see citing works
Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations
Grimshaw, J., & Russell, I. T. (1993) · The Lancet · doi:10.1016/0140-6736(93)92244-n · Cited by 2,791 · see citing works
Self-citationEffectiveness and Efficiency: Random Reflections on Health Services
L'Etang, H. (1973) · Public Health · doi:10.1016/s0033-3506(73)80082-4 · Cited by 1,905 · see citing works
Oxman, A. D., Thomson, M., Davis, D. A., & Haynes, R. B. (1995) · PubMed Central · Cited by 1,847 · see citing works
Fundamentals of Biostatistics.
Cornell, R. G., & ROSNER, B. A. (1987) · Journal of the American Statistical Association · doi:10.2307/2289416 · Cited by 1,630 · see citing works
Fundamentals of Biostatistics.
Barath, E., & ROSNER, B. A. (1992) · Biometrics · doi:10.2307/2532371 · Cited by 1,184 · see citing works
Protocol-Based Computer Reminders, the Quality of Care and the Non-Perfectability of Man
McDonald, C. J. (1976) · New England Journal of Medicine · doi:10.1056/nejm197612092952405 · Cited by 804 · see citing works
RECURRENT DISLOCATION OF THE SHOULDER
British Medical Journal Publishing Group (1929) · BMJ · doi:10.1136/bmj.2.3589.732 · Cited by 440 · see citing works
Experimental and quasi-experimental designs for evaluating guideline implementation strategies
Grimshaw, J. (2000) · Family Practice · doi:10.1093/fampra/17.suppl_1.s11 · Cited by 382 · see citing works
Self-citationTierney, W. M., Hui, S. L., & McDonald, C. J. (1986) · Medical Care · doi:10.1097/00005650-198608000-00001 · Cited by 337 · see citing works
Achieving health gain through clinical guidelines II: Ensuring guidelines change medical practice.
Grimshaw, J., & Russell, I. T. (1994) · BMJ Quality & Safety · doi:10.1136/qshc.3.1.45 · Cited by 328 · see citing works
Self-citationAnalysis of cluster randomized trials in primary care: a practical approach
Campbell, M. K., Mollison, J., Steen, N., Grimshaw, J. M., & Eccles, M. (2000) · Family Practice · doi:10.1093/fampra/17.2.192 · Cited by 327 · see citing works
Self-citationImplementing guidelines in general practice care.
Grol, R. P. T. M. (1992) · BMJ Quality & Safety · doi:10.1136/qshc.1.3.184 · Cited by 291 · see citing works
(1996) Low Back Pain Evidence Review London: Royal College of General Practitioners
Waddell, G., Feder, G. S., McIntosh, A., Lewis, M., & Hutchinson, A. (1998) · Journal of Manual & Manipulative Therapy · doi:10.1179/jmt.1998.6.3.151 · Cited by 187 · see citing works
Making the best use of a department of clinical radiology--guidelines for doctors.
Needham, G. (1996) · PubMed · Cited by 178 · see citing works
Self-citationOakeshott, P., Kerry, S., & Williams, J. E. F. (1994) · PubMed · Cited by 102 · see citing works
Do clinical guidelines improve general practice management and referral of infertile couples?
Emslie, C., Grimshaw, J., & Templeton, A. (1993) · BMJ · doi:10.1136/bmj.306.6894.1728 · Cited by 90 · see citing works
Self-citationMULTICENTRE TRIAL OF FOUR STRATEGIES TO REDUCE USE OF A RADIOLOGICAL TEST
Fowkes, F. G. R., Evans, K. T., Hartley, G., Nolan, D. J., Roberts, C. J., Davies, E. R., Green, G., Hugh, A. E., Power, A., & Roylance, J. (1986) · The Lancet · doi:10.1016/s0140-6736(86)92327-5 · Cited by 78 · see citing works
Kerry, S., Oakeshott, P., Dundas, D., & Williams, J. E. F. (2000) · Family Practice · doi:10.1093/fampra/17.1.46 · Cited by 77 · see citing works
Disseminating research, changing practice
Dunn, E. V. (1994) · Medical Entomology and Zoology · Cited by 63 · see citing works
Chronic low back pain in primary care: a prospective study on the management and course
van Tulder, M. W., Koes, B. W., Metsemakers, J. F. M., & Bouter, L. M. (1998) · Family Practice · doi:10.1093/fampra/15.2.126 · Cited by 59 · see citing works
IMPLEMENTATION OF GUIDELINES FOR THE USE OF SKULL RADIOGRAPHS IN PATIENTS WITH HEAD INTURIES
Fowkes, F. G. R., Williams, L. A., Cooke, B., Evans, R., Gehlbach, S. H., & Roberts, C. J. (1984) · The Lancet · doi:10.1016/s0140-6736(84)90715-3 · Cited by 46 · see citing works
An audit of knee radiographs performed for general practitioners.
Morgan, B., Mullick, S. P., Harper, W. M., & Finlay, D. B. (1997) · British Journal of Radiology · doi:10.1259/bjr.70.831.9166050 · Cited by 45 · see citing works
The effect of radiology guidelines for general practitioners in plymouth
Meiring, P. D. V., & Wells, I. P. (1990) · Clinical Radiology · doi:10.1016/s0009-9260(05)82146-4 · Cited by 30 · see citing works
Chest radiography guidelines for general practitioners: A practical approach
Bearcroft, P. W. P., Small, J., & Flower, C. D. R. (1994) · Clinical Radiology · doi:10.1016/s0009-9260(05)82916-2 · Cited by 28 · see citing works
Butt, W. P. (1989) · Clinical Radiology · doi:10.1016/s0009-9260(89)80004-2 · Cited by 21 · see citing works
Plain Radiography of the Lumbosacral Spine
Espeland, A., Albrektsen, G., & Larsen, J. L. (1999) · Acta Radiologica · doi:10.1080/02841859909174403 · Cited by 21 · see citing works
Does a reduction in general practitioners' use of diagnostic tests lead to more hospital referrals?
Winkens, R. A. G., Grol, R. P. T. M., Beusmans, G. H. M. I., Kester, A. D. M., Knottnerus, J. A., & Pop, P. (1995) · Europe PMC (PubMed Central) · Cited by 18 · see citing works
Flagged first, then by citations
2 of the 31 references couldn’t be matched to a known paper.
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Sorted by citations
Audit and feedback: effects on professional practice and healthcare outcomes
Ivers, N., Jamtvedt, G., Flottorp, S., Young, J. M., Odgaard-Jensen, J., French, S. D., O'Brien, M. A., Johansen, M., Grimshaw, J., & Oxman, A. D. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000259.pub3 · Cited by 5,485 · see citing works
Self-citationPrevention and treatment of low back pain: evidence, challenges, and promising directions
Foster, N. E., Anema, J. R., Cherkin, D., Chou, R., Cohen, S. P., Gross, D. P., Ferreira, P. H., Fritz, J. M., Koes, B. W., Peul, W., et al. (2018) · The Lancet · doi:10.1016/s0140-6736(18)30489-6 · Cited by 2,398 · see citing works
Audit and feedback: effects on professional practice and health care outcomes
Jamtvedt, G., Young, J. M., Kristoffersen, D. T., O'Brien, M. A., & Oxman, A. D. (2006) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000259.pub2 · Cited by 912 · see citing works
Printed educational materials: effects on professional practice and healthcare outcomes
Giguere, A. M. C., Légaré, F., Grimshaw, J., Turcotte, S., Fiander, M., Grudniewicz, A., Makosso‐Kallyth, S., Wolf, F. M., Farmer, A. P., & Gagnon, M. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004398.pub3 · Cited by 879 · see citing works
Self-citationResearch designs for studies evaluating the effectiveness of change and improvement strategies
Eccles, M. (2003) · Quality and Safety in Health Care · doi:10.1136/qhc.12.1.47 · Cited by 586 · see citing works
Self-citationPractice Feedback Interventions: 15 Suggestions for Optimizing Effectiveness
Brehaut, J., Colquhoun, H. L., Eva, K. W., Carroll, K. A., Sales, A. E., Michie, S., Ivers, N. M., & Grimshaw, J. (2016) · Annals of Internal Medicine · doi:10.7326/m15-2248 · Cited by 489 · see citing works
Self-citationAudit and feedback and clinical practice guideline adherence: Making feedback actionable
Hysong, S. J., Best, R. G., & Pugh, J. A. (2006) · Implementation Science · doi:10.1186/1748-5908-1-9 · Cited by 371 · see citing works
Jamtvedt, G., Young, J. M., Kristoffersen, D. T., O'Brien, M. A., & Oxman, A. D. (2006) · BMJ Quality & Safety · doi:10.1136/qshc.2006.018549 · Cited by 364 · see citing works
Interventions Aimed at Reducing Use of Low-Value Health Services: A Systematic Review
Colla, C. H., Mainor, A. J., Hargreaves, C., Sequist, T. D., & Morden, N. E. (2016) · Medical Care Research and Review · doi:10.1177/1077558716656970 · Cited by 358 · see citing works
Puffer, S., Torgerson, D., & Watson, J. (2003) · BMJ · doi:10.1136/bmj.327.7418.785 · Cited by 351 · see citing works
How to study improvement interventions: a brief overview of possible study types
Portela, M. C., Pronovost, P. J., Woodcock, T. M., Carter, P., & Dixon‐Woods, M. (2015) · BMJ Quality & Safety · doi:10.1136/bmjqs-2014-003620 · Cited by 319 · see citing works
Changing clinical behaviour by making guidelines specific
Michie, S., & Johnston, M. (2004) · BMJ · doi:10.1136/bmj.328.7435.343 · Cited by 309 · see citing works
Audit and feedback: effects on professional practice and health care outcomes
Jamtvedt, G., Young, J. G., Kristoffersen, D., O'Brien, M., & Oxman, A. D. (2003) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000259 · Cited by 285 · see citing works
Designing and undertaking randomised implementation trials: guide for researchers
Wolfenden, L., Foy, R., Presseau, J., Grimshaw, J., Ivers, N. M., Powell, B. J., Taljaard, M., Wiggers, J., Sutherland, R., Nathan, N., et al. (2021) · BMJ · doi:10.1136/bmj.m3721 · Cited by 279 · see citing works
Self-citationPrinted educational materials: effects on professional practice and health care outcomes
Farmer, A. P., Légaré, F., Turcot, L., Grimshaw, J., Harvey, E., McGowan, J., & Wolf, F. M. (2008) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004398.pub2 · Cited by 249 · see citing works
Self-citationGardner, B., Whittington, C., McAteer, J., Eccles, M. P., & Michie, S. (2010) · Social Science & Medicine · doi:10.1016/j.socscimed.2010.01.039 · Cited by 225 · see citing works
Self-citationMalone, J. F., Guleria, R., Craven, C. J., Horton, P., Järvinen, H., Mayo, J. R., O’reilly, G., Picano, E., Remedios, D., Heron, J. L., et al. (2012) · British Journal of Radiology · doi:10.1259/bjr/42893576 · Cited by 200 · see citing works
Improved Outcomes in a Quality Improvement Collaborative for Pediatric Inflammatory Bowel Disease
Crandall, W., Margolis, P. A., Kappelman, M. D., King, E. C., Pratt, J. M., Boyle, B. M., Duffy, L. F., Grunow, J. E., Kim, S. C., Leibowitz, I., et al. (2012) · PEDIATRICS · doi:10.1542/peds.2011-1700 · Cited by 190 · see citing works
Yoong, S. L., Hall, A. E., Stacey, F. G., Grady, A., Sutherland, R., Wyse, R., Anderson, A., Nathan, N., & Wolfenden, L. (2020) · Implementation Science · doi:10.1186/s13012-020-01011-0 · Cited by 184 · see citing works
Jenkins, H. J., Downie, A., Maher, C. G., Moloney, N. A., MAGNUSSEN, J. S., & Hancock, M. J. (2018) · The Spine Journal · doi:10.1016/j.spinee.2018.05.004 · Cited by 173 · see citing works
Arditi, C., Rège-Walther, M., Wyatt, J. C., Durieux, P., & Burnand, B. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001175.pub3 · Cited by 172 · see citing works
Verstappen, W. H. J. M., van der Weijden, T., Sijbrandij, J., Smeele, I. J. M., Hermsen, J., Grimshaw, J., & Grol, R. P. T. M. (2003) · PubMed · doi:10.1001/jama.289.18.2407 · Cited by 160 · see citing works
Self-citationFrench, S. D., McKenzie, J. E., O’Connor, D. A., Grimshaw, J., Mortimer, D., Francis, J., Michie, S., Spike, N., Schattner, P. L., Kent, P. M., et al. (2013) · PLoS ONE · doi:10.1371/journal.pone.0065471 · Cited by 153 · see citing works
Self-citationHall, A. M., Scurrey, S. R. M., Pike, A. E., Albury, C., Richmond, H., Matthews, J. J., Toomey, E. C., Hayden, J. A., & Etchegary, H. (2019) · Implementation Science · doi:10.1186/s13012-019-0884-4 · Cited by 149 · see citing works
Kim, Y., Chen, A. H., Keith, E., Yee, H. F., & Kushel, M. (2009) · Journal of General Internal Medicine · doi:10.1007/s11606-009-0955-3 · Cited by 150 · see citing works
Ethical issues posed by cluster randomized trials in health research
Weijer, C., Grimshaw, J., Taljaard, M., Binik, A., Boruch, R. F., Brehaut, J., Donner, A. P., Eccles, M., Gallo, A., McRae, A. D., et al. (2011) · Trials · doi:10.1186/1745-6215-12-100 · Cited by 143 · see citing works
Self-citationJenkins, H. J., Hancock, M. J., French, S. D., Maher, C. G., Engel, R. M., & MAGNUSSEN, J. S. (2015) · Canadian Medical Association Journal · doi:10.1503/cmaj.141183 · Cited by 143 · see citing works
Espeland, A., & Bærheim, A. (2003) · BMC Health Services Research · doi:10.1186/1472-6963-3-8 · Cited by 136 · see citing works
Walker, A. E., Grimshaw, J., Johnston, M., Pitts, N., Steen, N., & Eccles, M. (2003) · BMC Health Services Research · doi:10.1186/1472-6963-3-22 · Cited by 133 · see citing works
Self-citationOvertesting and undertesting in primary care: a systematic review and meta-analysis
O’Sullivan, J. W., Albasri, A., Nicholson, B. D., Perera, R., Aronson, J. K., Roberts, N. W., & Heneghan, C. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-018557 · Cited by 133 · see citing works
Lemmers, G. P. G., van Lankveld, W., Westert, G. P., van der Wees, P. J., & Staal, J. B. (2019) · European Spine Journal · doi:10.1007/s00586-019-05918-1 · Cited by 135 · see citing works
Discussion Sections in Reports of Controlled Trials Published in General Medical Journals
Clarke, M. J. (2002) · JAMA · doi:10.1001/jama.287.21.2799 · Cited by 123 · see citing works
Bonetti, D. L., Eccles, M., Johnston, M., Steen, N., Grimshaw, J., Baker, R. M., Walker, A. E., & Pitts, N. B. (2004) · Social Science & Medicine · doi:10.1016/j.socscimed.2004.08.072 · Cited by 120 · see citing works
Self-citationDoctors With a Special Interest in Back Pain Have Poorer Knowledge About How to Treat Back Pain
Buchbinder, R., Staples, M., & Jolley, D. (2009) · Spine · doi:10.1097/brs.0b013e318195d688 · Cited by 117 · see citing works
Mesner, S., Foster, N. E., & French, S. D. (2016) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-016-1110-z · Cited by 114 · see citing works
Greenwood-Lee, J., Jewett, L., Woodhouse, L. J., & Marshall, D. A. (2018) · BMC Health Services Research · doi:10.1186/s12913-018-3745-y · Cited by 119 · see citing works
Kobewka, D. M., Ronksley, P. E., McKay, J. A., Forster, A. J., & van Walraven, C. (2014) · Clinical Chemistry and Laboratory Medicine (CCLM) · doi:10.1515/cclm-2014-0778 · Cited by 113 · see citing works
Bhatia, R. S., Milford, C. E., Picard, M. H., & Weiner, R. B. (2013) · JACC. Cardiovascular imaging · doi:10.1016/j.jcmg.2013.01.010 · Cited by 105 · see citing works
Kaptoge, S., Armbrecht, G., Felsenberg, D., Lunt, M., O’Neill, T. W., Silman, A. J., REEVE, J., & on behalf of the EPOS Study Group (2004) · Journal of Bone and Mineral Research · doi:10.1359/jbmr.040901 · Cited by 102 · see citing works
Thomas, R. E., Croal, B. L., Ramsay, C. R., Eccles, M., & Grimshaw, J. (2006) · The Lancet · doi:10.1016/s0140-6736(06)68888-0 · Cited by 99 · see citing works
Self-citationNon-evidence-based variables affecting physicians' test-ordering tendencies: a systematic review.
Sood, R., Sood, A., & Ghosh, A. K. (2007) · PubMed · Cited by 100 · see citing works
Review: What Can We Learn From Quality Improvement Research?
Alexander, J. A., & Hearld, L. R. (2009) · Medical Care Research and Review · doi:10.1177/1077558708330424 · Cited by 91 · see citing works
Decision tools in health care: focus on the problem, not the solution
Liu, J. K., Wyatt, J. C., & Altman, D. G. (2006) · BMC Medical Informatics and Decision Making · doi:10.1186/1472-6947-6-4 · Cited by 90 · see citing works
Interventions for improving the appropriate use of imaging in people with musculoskeletal conditions
French, S. D., Green, S., Buchbinder, R., & Barnes, H. (2010) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006094.pub2 · Cited by 90 · see citing works
Doran, D. M., & Sidani, S. (2007) · Worldviews on Evidence-Based Nursing · doi:10.1111/j.1741-6787.2007.00073.x · Cited by 84 · see citing works
Audit and feedback: effects on professional practice
Ivers, N. M., Yogasingam, S., Lacroix, M., Brown, K. A., Antony, J., Soobiah, C., Simeoni, M., Willis, T. A., Crawshaw, J., Antonopoulou, V., et al. (2025) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000259.pub4 · Cited by 103 · see citing works
Self-citationMatowe, L. K., Ramsay, C. R., Grimshaw, J., Gilbert, F. J., MacLeod, M. J., & Needham, G. (2002) · Clinical Radiology · doi:10.1053/crad.2001.0894 · Cited by 78 · see citing works
Self-citationUsing audit and feedback to health professionals to improve the quality and safety of health care
Flottorp, S. A., Jamtvedt, G., Gibis, B., & McKee, M. (2010) · Cited by 77 · see citing works
McKenzie, J. E., French, S. D., O'Connor, D. A., Grimshaw, J. M., Mortimer, D., Michie, S., Francis, J., Spike, N., Schattner, P., Kent, P. M., et al. (2008) · Implementation Science · doi:10.1186/1748-5908-3-11 · Cited by 77 · see citing works
Self-citationA review identifies and classifies reasons for ordering diagnostic tests
Whiting, P. F., Toerien, M., de Salis, I. O. C., Sterne, J. A. C., Dieppe, P. A., Egger, M., & Fahey, T. P. (2007) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2007.01.012 · Cited by 75 · see citing works
Wang, S. Y., & Groene, O. (2020) · PLoS ONE · doi:10.1371/journal.pone.0234149 · Cited by 69 · see citing works
Rutterford, C. M., Taljaard, M., Dixon, S. N., Copas, A. J., & Eldridge, S. M. (2014) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2014.10.006 · Cited by 64 · see citing works
Informed appropriate imaging for low back pain management: A narrative review
Wáng, Y. X. J., Wu, A., Santiago, F. R., & Nogueira‐Barbosa, M. H. (2018) · Journal of Orthopaedic Translation · doi:10.1016/j.jot.2018.07.009 · Cited by 67 · see citing works
Blank, L., Baxter, S., Woods, H. B., Goyder, E., Lee, A., Payne, N., & Rimmer, M. (2014) · British Journal of General Practice · doi:10.3399/bjgp14x682837 · Cited by 64 · see citing works
Cadogan, S. L., Browne, J. P., Bradley, C., & Cahill, M. R. (2015) · Implementation Science · doi:10.1186/s13012-015-0356-4 · Cited by 61 · see citing works
Professional interventions for general practitioners on the management of musculoskeletal conditions
Tzortziou Brown, V., Underwood, M., Mohamed, N., Westwood, O., & Morrissey, D. (2016) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007495.pub2 · Cited by 62 · see citing works
Hutton, J. L., Eccles, M., & Grimshaw, J. (2008) · Implementation Science · doi:10.1186/1748-5908-3-52 · Cited by 62 · see citing works
Self-citationAbernethy, A. P., Currow, D. C., Hunt, R. W., Williams, H., Roder‐Allen, G., Rowett, D. S., Shelby‐James, T., Esterman, A., May, F. W., & Phillips, P. A. (2005) · Contemporary Clinical Trials · doi:10.1016/j.cct.2005.09.006 · Cited by 59 · see citing works
Martens, J. D., Werkhoven, M. J., Severens, J. L., & Winkens, R. A. G. (2007) · Journal of Evaluation in Clinical Practice · doi:10.1111/j.1365-2753.2006.00707.x · Cited by 57 · see citing works
Bahrami, M., Deery, C., Clarkson, J., Pitts, N. B., Johnston, M., Ricketts, I. W., MacLennan, G., Nugent, Z. J., Tilley, C., Bonetti, D. L., et al. (2004) · BDJ · doi:10.1038/sj.bdj.4811858 · Cited by 57 · see citing works
Verstappen, W. H. J. M. (2004) · The Annals of Family Medicine · doi:10.1370/afm.244 · Cited by 55 · see citing works
Estimating the probability of radiographic osteoarthritis in the older patient with knee pain
Peat, G., Thomas, E., Duncan, R., Wood, L. R. J., Wilkie, R., Hill, J. C., Hay, E. M., & Croft, P. R. (2007) · Arthritis Care & Research · doi:10.1002/art.22785 · Cited by 53 · see citing works
Tomás Pantoja, C., Grimshaw, J., Colomer, N., Castañón, C., & Léniz, J. (2019) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001174.pub4 · Cited by 53 · see citing works
Self-citationA Conceptual Framework for Understanding and Reducing Overuse by Primary Care Providers
Powell, A. A., Bloomfield, H. E., Burgess, D. J., Wilt, T. J., & Partin, M. R. (2013) · Medical Care Research and Review · doi:10.1177/1077558713496166 · Cited by 49 · see citing works
Setting the research agenda for improving health care in musculoskeletal disorders
Buchbinder, R., Maher, C. G., & Harris, I. A. (2015) · Nature Reviews Rheumatology · doi:10.1038/nrrheum.2015.81 · Cited by 48 · see citing works
Verstappen, W. H. J. M., van der Weijden, T., ter Riet, G., Grimshaw, J., Winkens, R. A. G., & Grol, R. P. T. M. (2004) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2004.03.009 · Cited by 48 · see citing works
Self-citationBussières, A., Peterson, C. K., & Taylor, J. A. M. (2007) · Journal of Manipulative and Physiological Therapeutics · doi:10.1016/j.jmpt.2007.10.003 · Cited by 47 · see citing works
Grimshaw, J., Eccles, M., Steen, N., Johnston, M., Pitts, N. B., Glidewell, L., MacLennan, G., Thomas, R. E., Bonetti, D. L., & Walker, A. E. (2011) · Implementation Science · doi:10.1186/1748-5908-6-55 · Cited by 46 · see citing works
Self-citationLin, I. B., Coffin, J., & O’Sullivan, P. (2016) · BMC Family Practice · doi:10.1186/s12875-016-0441-z · Cited by 46 · see citing works
Primary care referrals for lumbar spine radiography: diagnostic yield and clinical guidelines.
Hollingworth, W., Todd, C. J., King, H., Males, T., Dixon, A. K., KARIA, K. R., & Kinmonth, A. L. (2002) · Europe PMC (PubMed Central) · Cited by 46 · see citing works
Republished: How to study improvement interventions: a brief overview of possible study types
Portela, M. C., Pronovost, P. J., Woodcock, T. M., Carter, P., & Dixon‐Woods, M. (2015) · Postgraduate Medical Journal · doi:10.1136/postgradmedj-2014-003620rep · Cited by 45 · see citing works
Explaining variation in GP referral rates for x-rays for back pain
Baker, R. M., Lecouturier, J., & Bond, S. (2006) · Implementation Science · doi:10.1186/1748-5908-1-15 · Cited by 45 · see citing works
Self-citationHodder, R. K., Wolfenden, L., Kamper, S. J., Lee, H., Williams, A. J., O’Brien, K. M., & Williams, C. M. (2016) · Best Practice & Research Clinical Rheumatology · doi:10.1016/j.berh.2017.05.002 · Cited by 44 · see citing works
Logan, E. C. M., Yates, J. M., Stewart, R. M., Fielding, K., & Kendrick, D. (2002) · Postgraduate Medical Journal · doi:10.1136/pmj.78.923.533 · Cited by 44 · see citing works
Randomized controlled trials in de-implementation research: a systematic scoping review
Raudasoja, A., Falkenbach, P., Vernooij, R. W. M., Mustonen, J. M. J., Agarwal, A., Aoki, Y., Blanker, M. H., Cartwright, R., García‐Perdomo, H. A., Kilpeläinen, T. P., et al. (2022) · Implementation Science · doi:10.1186/s13012-022-01238-z · Cited by 43 · see citing works
Bandong, A. N., Leaver, A. M., Mackey, M., Ingram, R., Shearman, S., Chan, C., Cameron, I. D., Moloney, N. A., Mitchell, R. J., Doyle, E., et al. (2018) · BMC Health Services Research · doi:10.1186/s12913-018-3439-5 · Cited by 43 · see citing works
O’Connor, D. A., Glasziou, P., Maher, C. G., McCaffery, K. J., Schram, D., Maguire, B., Ma, R., Billot, L., Gorelik, A., Traeger, A. C., et al. (2022) · JAMA · doi:10.1001/jama.2022.14587 · Cited by 43 · see citing works
Irwin, P., Hoffman, A., Lowe, D., Pearson, M. G., & Rudd, A. G. (2005) · Journal of Evaluation in Clinical Practice · doi:10.1111/j.1365-2753.2005.00529.x · Cited by 43 · see citing works
Ammendolia, C., Hogg‐Johnson, S., Bombardier, C., Pennick, V., & Glazier, R. H. (2004) · Journal of Manipulative and Physiological Therapeutics · doi:10.1016/j.jmpt.2003.12.021 · Cited by 43 · see citing works
McKenzie, J. E., O'Connor, D. A., Page, M. J., Mortimer, D. S., French, S. D., Walker, B. F., Keating, J. L., Grimshaw, J. M., Michie, S., Francis, J. J., et al. (2010) · Implementation Science · doi:10.1186/1748-5908-5-86 · Cited by 42 · see citing works
Self-citationFarmer, C., Bourne, A., O’Connor, D. A., Jarvik, J. G., & Buchbinder, R. (2020) · Insights into Imaging · doi:10.1186/s13244-020-00864-9 · Cited by 40 · see citing works
Assessing the Long-term Effect of Educational Reminder Messages on Primary Care Radiology Referrals
Ramsay, C. R., Eccles, M., Grimshaw, J., & Steen, N. (2003) · Clinical Radiology · doi:10.1016/s0009-9260(02)00524-x · Cited by 40 · see citing works
Self-citationon behalf of the ASPIRE programme team, Glidewell, L., Willis, T. A., Petty, D. R., Lawton, R., McEachan, R., Ingleson, E., Heudtlass, P., Davies, A., Jamieson, T., et al. (2018) · Implementation Science · doi:10.1186/s13012-017-0704-7 · Cited by 38 · see citing works
Blank, L., Baxter, S. K., Woods, H. B., Goyder, E., Lee, A. C., Payne, N., & Rimmer, M. (2015) · Health Services and Delivery Research · doi:10.3310/hsdr03240 · Cited by 37 · see citing works
Eccles, M., Johnston, M., Hrisos, S., Francis, J., Grimshaw, J., Steen, N., & Kaner, E. (2007) · Implementation Science · doi:10.1186/1748-5908-2-27 · Cited by 38 · see citing works
Self-citationFervers, B., Carretier, J., & Bataillard, A. (2010) · Journal of Visceral Surgery · doi:10.1016/j.jviscsurg.2010.10.010 · Cited by 37 · see citing works
Lineker, S. C., & Husted, J. (2010) · The Journal of Rheumatology · doi:10.3899/jrheum.100045 · Cited by 34 · see citing works
Effectiveness of GP access to magnetic resonance imaging of the knee: a randomised trial
Damask Trial Team (2008) · British Journal of General Practice · doi:10.3399/bjgp08x342651 · Cited by 35 · see citing works
Martens, J. D., Winkens, R. A. G., van der Weijden, T., de Bruyn, D., & Severens, J. L. (2006) · BMC Health Services Research · doi:10.1186/1472-6963-6-145 · Cited by 33 · see citing works
Patel, S., Rajkomar, A., Harrison, J. D., Prasad, P. A., Valencia, V. E., Ranji, S. R., & Mourad, M. (2018) · BMJ Quality & Safety · doi:10.1136/bmjqs-2017-007393 · Cited by 32 · see citing works
The Enhancing Secondary Prevention in Coronary Artery Disease trial
McAlister, F. A., Fradette, M., Majumdar, S. R., Williams, R., Graham, M. M., McMeekin, J., Ghali, W. A., Tsuyuki, R. T., Knudtson, M. L., & Grimshaw, J. (2009) · Canadian Medical Association Journal · doi:10.1503/cmaj.090917 · Cited by 31 · see citing works
Self-citationMortimer, D., French, S. D., McKenzie, J. E., O′Connor, D. A., & Green, S. E. (2013) · PLoS ONE · doi:10.1371/journal.pone.0075647 · Cited by 30 · see citing works
Wang, K. Y., Yen, C., Chen, M., Variyam, D. E., Uribe, T., Reed, B. C., Wintermark, M., & Lincoln, C. M. M. (2017) · Journal of the American College of Radiology · doi:10.1016/j.jacr.2017.08.005 · Cited by 31 · see citing works
Mdege, N. D., Brabyn, S., Hewitt, C. E., Richardson, R., & Torgerson, D. J. (2014) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2014.06.004 · Cited by 29 · see citing works
Justification and active guideline implementation for spine radiography referrals in primary care
Tahvonen, P. R., Oikarinen, H., Niinimäki, J. L., Liukkonen, E., Mattila, S. I., & Tervonen, O. A. (2016) · Acta Radiologica · doi:10.1177/0284185116661879 · Cited by 28 · see citing works
Farmer, C., O’Connor, D. A., Lee, H., McCaffery, K. J., Maher, C. G., Newell, D., Cashin, A. G., Byfield, D. C., Jarvik, J. G., & Buchbinder, R. (2021) · BMJ Open · doi:10.1136/bmjopen-2021-049938 · Cited by 28 · see citing works
General practitioners’ knowledge of whiplash guidelines improved with online education
Rebbeck, T. J., Macedo, L. G., Paul, P. R., Trevena, L. J., & Cameron, I. D. (2013) · Australian Health Review · doi:10.1071/ah13057 · Cited by 27 · see citing works
Martens, J. D., van der Weijden, T., Winkens, R. A. G., Kester, A. D. M., Geerts, P. J. H., Evers, S., & Severens, J. L. (2007) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2007.05.013 · Cited by 27 · see citing works
Brealey, S., Atwell, C., Bryan, S., Coulton, S., Cox, H., Cross, B., Fylan, F., Garratt, A., Gilbert, F. J., Gillan, M. G., et al. (2006) · BMC Health Services Research · doi:10.1186/1472-6963-6-133 · Cited by 27 · see citing works
Self-citation
- Authors
- Eccles, M., Steen, N., Grimshaw, J., Thomas, L., McNamee, P., Soutter, J., Wilsdon, J., Matowe, L., Needham, G., Gilbert, F., & Bond, S.
- Affiliations
- Newcastle University (GB)
- University of Aberdeen (GB)
- Newcastle upon Tyne Hospital (GB)
- Aberdeen Royal Infirmary (GB)
- Corresponding author
- Eccles, Martin
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2001-05
- Volume
- 357
- Issue
- 9266
- Pages
- 1406-1409
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2123697166
- Cited by
- 222
- References
- 31
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 6 · 2023: 10 · 2022: 10 · 2021: 7 · 2020: 18 · 2019: 8 · 2018: 13 · 2017: 3 · 2016: 12 · 2015: 11 · 2014: 7 · 2013: 11 · 2012: 6
- FWCI
- 23.80
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- CLOK (University of Central Lancashire) (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- Royal College of Radiologists
- Topics
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiology practices and education
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- audit and feedback, lumbar spine radiographs, knee radiographs, guideline adherence, general practitioners, radiology department
- MeSH terms
- Adult, England, Family Practice, Feedback, Humans, Knee, Lumbar Vertebrae, Radiography, Referral and Consultation, Scotland, Cluster Analysis, Reminder Systems, Practice Guidelines as Topic
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