In Reply: We agree with Dr Bohnen that our article provided no comparison with single strategies, and that this undermines our conclusion that our findings confirmed that multifaceted strategies are superior to single strategies. We disagree with him, however, that our strategy is more time-consuming for physicians than computerized decision support. Although organizing our intervention did require a great deal of effort, it did not take much of the participating physicians' time (ie, three 90-minute meetings per year). The implementation of this method was not unduly difficult; the strategy not only fit in well within the routine practice and routine professional education of physicians, but also was linked to the everyday practice work and the physicians' need to interact with colleagues. Our strategy allows everyday test-ordering problems such as patients' demands for tests and changing guidelines to be discussed and perhaps solved in an open and respectful discussion, using social influence as a motivator for change. Some data suggest that participating in such quality-improvement activities may increase job satisfaction.1,2
Verstappen WHJM, van der Weijden T, Grol RPTM. Strategies to Improve Test Ordering in Primary Care—Reply. JAMA. 2003;290(17):2253–2254. doi:10.1001/jama.290.17.2253a
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