Matowe 2002.
| Methods | Study design: ITS | |
| Participants | Physicians Clinical speciality: radiology Level of training: fully trained Setting/country: general practice/UK |
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| Interventions | To evaluate the effect of postal dissemination of the third edition of the RCR guidelines on GP referral for radiography. The RCR guidelines were introduced to encourage appropriate use of diagnostic radiology and reduce the use of clinically unhelpful examinations. Between 1989 and 1998 4 editions of these guidelines were produced and a large number of copies distributed by mail to primary care. The current edition of the guideline includes 285 individual recommendations | |
| Outcomes | 1 process outcome: total number of x‐ray referrals | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Intervention independent of other changes ‐ ITS | Unclear risk | No information was provided |
| Shape of Intervention effect pre‐specified ‐ ITS | Low risk | COMMENT: the authors specifically refer to reductions in x‐ray requests found by other studies and propose an ITS study of longer duration to improve the detection of the effect. They verified if other guidelines were disseminated independent of this study, and they also evaluated the effect of guidelines for 18 radiology examinations |
| Intervention unlikely to affect data collection ‐ ITS | Low risk | The intervention did not affect the data source (hospital radiology department records), and sources and methods of data collection were the same before and after the intervention |
| Blinding of outcome assessors (detection bias) ‐ ITS All outcomes | Low risk | The outcome was objective |
| Incomplete outcome data (attrition bias) ‐ ITS All outcomes | Low risk | Quote, pg. 576: "data were abstracted from the computerized administrative systems of two radiology departments serving over 90% of general practices in the region" COMMENT: missing data from GPs not using these radiology departments is not considered but it is not a high proportion (10%) |
| Selective reporting (reporting bias) ‐ ITS | Low risk | All relevant outcomes in the methods section were reported in the results section |
| Other bias ‐ ITS | Low risk | There was no evidence of other risks of bias |