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

Completed

Conditions: nexplained complaints: those complaints in which the GP, after clarifying the reason for encounter, history taking and performing physical examination cannot establish a diagnosis.

Lead Sponsor: a. University of Maastricht, Care and Public Health Research Institute (CAPHRI), Department of General Practice.PO Box 6166200 MD MaastrichtThe Netherlandsb. Academic Medical Center - University of Amsterdam, Division of Clinical Methods & Public Health, Department of General PracticeJ3-370PO Box 226601100 DD AmsterdamThe Netherlands

Brief Summary: BMC Fam Pract. 2006 Mar 22;7:20. 1. van Bokhoven MA, van der Weijden T, Dinant G-J. Challenges in the methodology of diagnostic research on patients presenting with unexplained complaints in general practice. J Clin Epidemiol, accepted for publication. 2. Koch H, Meerkerk GJ, Zaat JO, Ham MF, Scholten RJ, Assendelft WJ. Accuracy of carbohydrate-deficient Transferrine in the detection of excessive alcoholconsumption: a systematic review. Alcohol 2004;39:75-85. 3. van Bokhoven MA, Kok G, van der Weijden T. Designing a quality improvement intervention: a systematic approach. Qual Saf Health Care 2003;12:215-220. 4. van der Weijden T, van Bokhoven MA, Dinant GJ, van Hasselt CM, Grol RP. Understanding laboratory testing in diagnostic uncertainty: a qualitative study in general practice. Br J Gen Pract 2002;52:974-80. 5. Dinant GJ, van Wijk MAM, Janssens HJEM et al. Dutch College of General Practitioners guideline 'Blood testing. General principles and use under direct management. [NHG-standaard bloedonderzoek. Algemene principes en uitvoering in eigen beheer]. Huisarts Wet 1994;37:202-211.

Recruitment & Eligibility

Inclusion Criteria

1. Patients of 18 years and above
with unexplained fatigue;

Exclusion Criteria

The GP is worried that the patient has got serious pathology that makes watchful waiting unacceptable.

Primary Outcome Measures

Name	Time	Method
1. Accuracy of blood tests for serious pathology (per test and in combinations relevant for general practice), related and in addition to signs and symptoms, at the moment of presentation and after postponing test ordering for four weeks;<br><br />2. Adherence of GPs to instruction either to order blood tests directly or after a watchful waiting policy of four weeks.

Secondary Outcome Measures

Name	Time	Method
1. Incidence of unexplained complaints in general practice;<br /><br>2. Predictive value of GPs working hypothesis;<br><br />3. Duration of unexplained complaints;<br><br />4. Effect of unexplained complaints on quality of life of patients;<br><br />5. Effect of direct testing or watchful waiting on satisfaction with care, anxiety, medical consumption and absence from work of patients;<br><bR>6. Effect of direct testing or watchful waiting on satisfaction, anxiety and insecurity of GPs;<br><Br>7. Effect of quality improvement intervention on knowledge about the value of blood test ordering in unexplained complaints, communication skills and attitudes of GPs;<br><br />8. Barriers to and facilitators of proposing a watchful waiting strategy by GPs;<br><br />9. Costs of the quality improvement intervention.