title: The effect of watchful waiting compared to immediate test ordering instructions on general practitioners' blood test ordering behaviour for patients with unexplained complaints; a randomized clinical trial (ISRCTN55755886).
abstract: BACKGROUND
  Immediate blood testing for patients presenting with unexplained complaints in family practice is superfluous from a diagnostic point of view. However, many general pracitioners (GPs) order tests immediately. Watchful waiting reduces the number of patients to be tested and the number of false-positive results. The objectives of this study are: to determine the feasibility of watchful waiting compared to immediate test ordering; to determine if a special quality improvement strategy can improve this feasibility; and to determine if watchful waiting leads to testing at a later time.
  
  
  METHODS
  The study is a cluster-randomized clinical trial with three groups, on blood test ordering strategies in patients with unexplained complaints. GPs in group one were instructed to order tests immediately and GPs in group two to apply a watchful waiting approach. GPs in group three received the same instruction as group two, but they were supported by a systematically designed quality improvement strategy. A total of 498 patients with unexplained complaints from 63 practices of Dutch GPs participated. We measured: the percentage of patients for whom tests were ordered and number of tests ordered at the first consultation; performance on the strategy's performance objectives (i.e., ordering fewer tests and specific communication skills); the number of tests ordered after four weeks; and GP and patient characteristics.
  
  
  RESULTS
  Immediate test ordering proved feasible in 92% of the patients; watchful waiting in 86% and 84%, respectively, for groups two and three. The two watchful waiting groups did not differ significantly in the achievement of any of the performance objectives. Of the patients who returned after four weeks, none from group one and six from the two watchful waiting groups had tests ordered for them.
  
  
  CONCLUSIONS
  Watchful waiting is a feasible approach. It does not lead to testing immediately afterwards. Furthermore, watchful waiting was not improved by the quality improvement strategy.
  
  
  BACKGROUND
  
  
  
  BACKGROUND
  ISRCTN55755886.
authors.affiliation: Maastricht University, CAPHRI School for Public Health and Primary care, Department of General Practice, PO Box 616, 6200, MD Maastricht, The Netherlands. loes.vanbokhoven@maastrichtuniversity.nl
authors.forename: Marloes A
authors.initials: MA
authors.lastname: van Bokhoven
authors.forename: Hèlen
authors.initials: H
authors.lastname: Koch
authors.forename: Trudy
authors.initials: T
authors.lastname: van der Weijden
authors.forename: Anuska H M
authors.initials: AH
authors.lastname: Weekers-Muyres
authors.forename: Patrick J E
authors.initials: PJ
authors.lastname: Bindels
authors.forename: Richard P T M
authors.initials: RP
authors.lastname: Grol
authors.forename: Geert-Jan
authors.initials: GJ
authors.lastname: Dinant
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D005194:Family Practice / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D008875:Middle Aged; D009426:Netherlands; D011364:Professional Practice; D058996:Quality Improvement; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013001:Somatoform Disorders / Q000209:etiology*; D019564:Unnecessary Procedures / Q000706:statistics & numerical data; D057832:Watchful Waiting; D055815:Young Adult