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Table 5 Refinement of clinician support package following the learning in the pilot trial

From: Integrating clinician support with intervention design as part of a programme testing stratified care for musculoskeletal pain in general practice

Problems identified in pilot Action taken before main trial
• Cumbersome questionnaire wording and variable use of terms • Design and validation of specific clinical version, with constructs stated for GPs
• Sub-optimal treatment recommendations • Rationalisation and refinement
• Excessive length of clinician support sessions and requests to re-focus some parts • Reduced to one 2 h session with less background information
• Trainers reluctant to specify best fit of intervention within consultation • Application of experience gained to be more directive, including production of video of simulated consultation for training
• Some GPs missed clinician support sessions • Training logs and prompt sheets introduced for each practice
• Delays in detecting problems and taking remedial action with practices • Early monitoring and re-visit to practice.
• Monthly feedback and personal contact by same trainer
• Poor engagement and performance by control practices • Control and intervention practices to have training visit from GP and clinical researcher from study team
• More focused clinician support sessions for control practices