No significant cluster effects (practice, therapist or teacher) were found, except for enablement, where a practice clustering effect was found, so only these results are presented allowing for clustering.
In order to avoid recruitment bias the identification of potential patients from the general practice information system will be performed before the allocation of a general practice cluster to a treatment strategy [ 19, 20].
13 All analyses took the form of multilevel linear regression models (using the Stata command 'xtmixed') with a random effect on practice (cluster).
Held, for example, considers it to be "both a practice, or cluster of practices, and a value, or cluster of values" and distinguishes this from the characteristics (dispositions) of caring persons [ 45].
However, several potential weaknesses in the design of PDGPD are acknowledged: first, the voluntary nature of GP participation in the cluster design where a practice [cluster] agreed to participate but not all GPs in the practice received the intervention.
This study is a practice based, cluster randomised controlled intervention study in an integrated primary care setting in the Netherlands.
Secondly, the risk of contamination between groups would have been much greater and therefore would have meant using a practice level, cluster randomised design, with consequent effects on the scale and feasibility of the trial.
Children testing negative on this tree presenting to primary care will either get a POC CRP test, or usual care, depending on their per practice cluster randomisation, as described by Lemiengre et al. [ 22].
All patients were recruited prior to practice cluster randomisation.
Randomisation is at the level of the general practice (cluster).
Participants implicitly defined 'local' in different ways, including at the practice, cluster of practices, and PCT levels.
