Objective. The GRIF automated feedback system produces real-time comments on the appropriateness of diagnostic tests ordered by general practitioners (GPs) based on recommendations from accepted national and regional practice guidelines. We investigated the experiences of GPs with this system and, more speciWcally, with the recommendations produced by the system as well as their views on using this system in daily practice. Setting. We tested the GRIF system in an experiment in a laboratory

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... ing and in a daily practice trial. Study participants. General practitioners. Intervention. In the laboratory experiment, GPs used the GRIF system to assess the appropriateness of 30 request forms. Each of the GPs was confronted with requests they had submitted to the diagnostic unit of the hospital in the past. In the Weld trial, the GRIF system was applied during patient consultations for 1 year. Main outcome measures. We measured GPs' satisfaction with the system using a questionnaire, and also conducted group discussions (in the laboratory experiment) and in-depth interviews (in the Weld trial) to elicit GPs' opinions of and experiences with the system. In addition, we explored GPs' reasons for not accepting the comments offered by the GRIF system. Results. The results show that the GPs in the laboratory experiment had more positive attitudes towards the system compared with participants in the Weld trial. All discussion groups and most of the GPs in the Weld trial regarded receiving the immediate feedback during the test ordering process as an important advantage. The most frequently mentioned reason to reject the recommendation was disagreement with the content and/or the recommendations in the practice guidelines. Conclusion. Apart from securing agreement on guideline content, a prerequisite for using GRIF in daily practice on a large scale is that more attention is paid to promotion of the guidelines and their adoption, and stimulation of a positive attitude towards the practice guidelines among the users.