title: Assessing the long-term effect of educational reminder messages on primary care radiology referrals.
abstract: OBJECTIVE
  To investigate whether the effect of educational reminder messages for knee and lumbar spine radiographs varied over a 12 month period.
  
  
  METHODS
  In a previous randomized, controlled trial, educational reminder messages attached to x-ray reports were shown to be effective in reducing the number of radiograph requests by general practitioners for knee and lumbar spine radiographs. In this study, all radiology departments from the previous trial were asked for monthly referral records for the 12 month intervention period for knee and lumbar spine radiographs for each general practice. Poisson regression was used to test for a change over time in the number of referrals between control and intervention practices.
  
  
  RESULTS
  Data were obtained for 66% of the general practices in the main trial. The number of referrals for both knee and lumbar spine radiographs remained consistently and statistically significantly lower in the educational reminder messages group compared with the control group (relative risk=0.65 and 0.64, respectively). There was no evidence that this difference increased or decreased throughout the 12 month period.
  
  
  CONCLUSIONS
  The effect of educational reminder messages was produced as soon as the intervention was delivered and maintained throughout the intervention period. There was no evidence of the effect of the intervention wearing off.
authors.affiliation: Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, UK. c.r.ramsay@abdn.ac.uk
authors.forename: C R
authors.initials: CR
authors.lastname: Ramsay
authors.forename: M
authors.initials: M
authors.lastname: Eccles
authors.forename: J M
authors.initials: JM
authors.lastname: Grimshaw
authors.forename: N
authors.initials: N
authors.lastname: Steen
mesh_terms: D005194:Family Practice / Q000706:statistics & numerical data*; D019983:Guideline Adherence; D006801:Humans; D007717:Knee / Q000000981:diagnostic imaging; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D011859:Radiography; D011872:Radiology Department, Hospital / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D017010:Reminder Systems; D012621:Seasons; D013997:Time Factors; D006113:United Kingdom