VAgue Medical Problems In REsearch (VAMPIRE). Blood test ordering for unexplained complaints in general practice.

Title:

'Blood test ordering for unexplained complaints in general practice (VAMPIRE)'




Objectives:

to determine the course of unexplained complaints, to determine the accuracy of (combinations of) diagnostic tests, including signs symptoms and contextual factors in patients presenting with unexplained complaints, to determine the cost-effectiveness of a watchful waiting strategy of a month compared to direct blood test ordering, to systematically design a quality improvement strategy for GPs aiming at postponement of blood test ordering in patients with unexplained complaints, to determine the cost-effectiveness of this quality improvement strategy.




Design:

on GP level randomised clinical trial with three arms. GPs in arm 1 order blood tests immediately, GPs in arm 2 suggest a watchful waiting strategy of four weeks and order blood tests only when complaints persist, GPs in arm 3 also postpone blood test ordering but are also supported by a systematically developed quality improvement strategy. Follow-up of patients is one year. A delayed type cross sectional study is performed to establish a diagnosis after a year.

1. When patients visit their GPs with unexplained complaints it is cost effective to follow a watchful waiting strategy of four weeks before ordering laboratory tests;

2. A systematically developed quality improvement strategy, based on barriers and facilitators of GPs' blood test ordering behaviour, is cost effective in supporting GPs to postpone blood test ordering.

N/A

1. Immediate blood test ordering versus watchful waiting of 4 weeks with blood test ordering after four weeks only if complaints remain;

2. Quality improvement strategy consisting of small group meetings, practice visits, patient leaflets and waiting room videotape versus no quality improvement strategy.