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