title: A cluster randomized controlled trial aimed at implementation of local quality improvement collaboratives to improve prescribing and test ordering performance of general practitioners: study protocol.
abstract: BACKGROUND
  The use of guidelines in general practice is not optimal. Although evidence-based methods to improve guideline adherence are available, variation in physician adherence to general practice guidelines remains relatively high. The objective for this study is to transfer a quality improvement strategy based on audit, feedback, educational materials, and peer group discussion moderated by local opinion leaders to the field. The research questions are: is the multifaceted strategy implemented on a large scale as planned?; what is the effect on general practitioners' (GPs) test ordering and prescribing behaviour?; and what are the costs of implementing the strategy?
  
  
  METHODS
  In order to evaluate the effects, costs and feasibility of this new strategy we plan a multi-centre cluster randomized controlled trial (RCT) with a balanced incomplete block design. Local GP groups in the south of the Netherlands already taking part in pharmacotherapeutic audit meeting groups, will be recruited by regional health officers. Approximately 50 groups of GPs will be randomly allocated to two arms. These GPs will be offered two different balanced sets of clinical topics. Each GP within a group will receive comparative feedback on test ordering and prescribing performance. The feedback will be discussed in the group and working agreements will be created after discussion of the guidelines and barriers to change. The data for the feedback will be collected from existing and newly formed databases, both at baseline and after one year.
  
  
  CONCLUSIONS
  We are not aware of published studies on successes and failures of attempts to transfer to the stakeholders in the field a multifaceted strategy aimed at GPs' test ordering and prescribing behaviour. This pragmatic study will focus on compatibility with existing infrastructure, while permitting a certain degree of adaptation to local needs and routines.
authors.affiliation: Maastricht University, Dept. of General Practice, School for Public Health and Primary Care (CAPRHI), Maastricht, The Netherlands. jasper.trietsch@hag.unimaas.nl
authors.forename: Jasper
authors.initials: J
authors.lastname: Trietsch
authors.forename: Trudy
authors.initials: T
authors.lastname: van der Weijden
authors.forename: Wim
authors.initials: W
authors.lastname: Verstappen
authors.forename: Rob
authors.initials: R
authors.lastname: Janknegt
authors.forename: Paul
authors.initials: P
authors.lastname: Muijrers
authors.forename: Ron
authors.initials: R
authors.lastname: Winkens
authors.forename: Ben
authors.initials: B
authors.lastname: van Steenkiste
authors.forename: Richard
authors.initials: R
authors.lastname: Grol
authors.forename: Job
authors.initials: J
authors.lastname: Metsemakers