Can consultation between the radiologist and patients contribute to reducing unnecessary radiological examinations?

  • Saša Staparski Dobravec Community Health Centre Ljubljana, Ljubljana, Slovenia
  • Zala Kumše Gale Community Health Centre Ljubljana, Ljubljana, Slovenia
  • Irena Makivić Community Health Centre Ljubljana, Ljubljana, Slovenia
Keywords: low back pain, x-ray scan, referral, cost benefit, medical advice

Abstract

Background: Clinical guidelines for managing non-specific back pain do not recommend X-ray imaging within 4–6 weeks from the onset of pain. The overstrain on radiology departments due to inappropriately indicated imaging prompted the introduction of consultations with radiologists. The new practice was started at the Community Health Centre Ljubljana (CHCL) in January 2013. Thus, the possibility of consultation is offered to all patients between 25 and 45 years of age, referred to spinal X-ray.
Methods: Quantitative analysis included all spinal X-ray imagings performed at CHCL from 2011 to 2018. The data were compared with those of two other Slovenian outpatient radiological departments. Qualitative evaluation of consultation implementation was done with a survey, which was sent to all patients (N:497) who had undergone consultation, as well as to their referring physicians (N:134) in the beginning of 2016.
Results: The number of referrals in CHCL is declining. The survey response rate was 48 % for referral physicians and 30 % for patients. The majority of physicians (95 %) expressed an opinion that the postponing or resigning of imaging did not cause delay of diagnostic or therapeutic procedure. Most of them (95.9 %) evaluated consultation as reasonable. Patients evaluated the acquired information as understandable (N = 136; 97.1 %), useful (N = 113; 89.7 %) and something new (N = 91; 72.8 %).
Conclusion: Introduction of patients’ consultations with a radiologist may reduce the number of non-indicated referrals. It is a simple, legitimate, professionally justified, harmless and cost-efficient service in radiology practice, which allows a direct personal transfer of medical experience and specific radiological expertise to the patient.

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References

Lidgren L. The bone and joint decade 2000-2010. Bull World Health Organ. 2003;81(9):629. https://pubmed.ncbi.nlm.nih.gov/14710501

Bevan S. Economic impact of musculoskeletal disorders (MSDs) on work in Europe. Best Pract Res Clin Rheumatol. 2015;29(3):356-73. https://doi.org/10.1016/j.berh.2015.08.002 https://pubmed.ncbi.nlm.nih.gov/26612235

Bilban M, Djomba KJ. Zdravstveni absentizem in bolezni gibal. Delo in Varnost. 2007;52(5):10-9.

Kazalniki bolniškega staleža po spolu, starosti in skupinah bolezni za leto. 2016[cited 2018 Aug 26]. Available from: https://podatki.nijz.si

Bigos SJ, Bowyer OR, Braen GR, Brown KC, Deyo RA, Haldeman S, et al. Acute low back problems in adults. In: Clinical Practice Guideline No. 14. AHCPR Publication No. 95-0642. Rockville, Maryland: Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services; 1994.

Koes BW, van Tulder MW, Thomas S. Diagnosis and treatment of low back pain. BMJ. 2006;332(7555):1430-4. https://doi.org/10.1136/bmj.332.7555.1430 https://pubmed.ncbi.nlm.nih.gov/16777886

Sizer PS, Brismée JM, Cook C. Medical screening for red flags in the diagnosis and management of musculoskeletal spine pain. Pain Pract. 2007;7(1):53-71. https://doi.org/10.1111/j.1533-2500.2007.00112.x https://pubmed.ncbi.nlm.nih.gov/17305681

Hoy D, Brooks P, Blyth F, Buchbinder R. The Epidemiology of low back pain. Best Pract Res Clin Rheumatol. 2010;24(6):769-81. https://doi.org/10.1016/j.berh.2010.10.002 https://pubmed.ncbi.nlm.nih.gov/21665125

Patel ND, Broderick DF, Burns J, Deshmukh TK, Fries IB, Harvey HB, et al. ACR Appropriateness Criteria Low Back Pain. J Am Coll Radiol. 2016;13(9):1069-78. https://doi.org/10.1016/j.jacr.2016.06.008 https://pubmed.ncbi.nlm.nih.gov/27496288

Antolič V, Pavlovčič V. Ortopedija. Ljubljana: samozaložba; 2006. pp. 257-82.

Van Tulder M, Becker A, Bekkering T, Breen A, del Real MT, Hutchinson A, et al. Eur Spine J. 2006;15:169-91.

Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, et al.; COST B13 Working Group on Guidelines for Chronic Low Back Pain. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15(S2):S192-300. https://doi.org/10.1007/s00586-006-1072-1 https://pubmed.ncbi.nlm.nih.gov/16550448

Koes BW, van Tulder M, Lin CW, Macedo LG, McAuley J, Maher C. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J. 2010;19(12):2075-94. https://doi.org/10.1007/s00586-010-1502-y https://pubmed.ncbi.nlm.nih.gov/20602122

van Tulder MW, Assendelft WJ, Koes BW, Bouter LM. Spinal radiographic findings and nonspecific low back pain. A systematic review of observational studies. Spine. 1997;22(4):427-34. https://doi.org/10.1097/00007632-199702150-00015 https://pubmed.ncbi.nlm.nih.gov/9055372

Jarvik JG, Deyo RA. Diagnostic evaluation of low back pain with emphasis on imaging. Ann Intern Med. 2002;137(7):586-97. https://doi.org/10.7326/0003-4819-137-7-200210010-00010 https://pubmed.ncbi.nlm.nih.gov/12353946

Jevtič V. Računalniška in magnetnoresonančna tomografija pri bolečini v križu. In: Antolič V, Vengust R, Pompe B, ur. Hrbtenica, klinične poti zdravljenja. Ljubljana: Ortopedska klinika; 2009. pp. 25-7.

Jevtič V. Uporabnost računalniškotomografskih in magnetnoresonančnih preiskav v diagnostiki bolečine v križu. Rehabilitacija. 2005;4(3-4):20-5.

European commission. Radiation protection 118, Update Mars 2008. Referral Guidelines for Imaging. 2007[cited 2018 Aug 26]. Available from: http://www.mlsi.gov.cy/mlsi/dli/dliup.nsf/All/815A41AAFA78D0D1C2257E29004188B9/$file/RP118.pdf

Linet MS, Slovis TL, Miller DL, Kleinerman R, Lee C, Rajaraman P, et al. Cancer risks associated with external radiation from diagnostic imaging procedures. CA Cancer J Clin. 2012;62(2):75-100. https://doi.org/10.3322/caac.21132 https://pubmed.ncbi.nlm.nih.gov/22307864

Committee to Assess Health Risks from Exposure to Low Level of Ionizing Radiation. Health risks from exposure to low levels of ionizing radiation : BEIR VII, Phase 2. Washington: National Academies Press; 2006.

Fazel R, Krumholz HM, Wang Y, Ross JS, Chen J, Ting HH, et al. Exposure to low-dose ionizing radiation from medical imaging procedures. N Engl J Med. 2009;361(9):849-57. https://doi.org/10.1056/NEJMoa0901249 https://pubmed.ncbi.nlm.nih.gov/19710483

Srinivas SV, Deyo RA, Berger ZD. Application of “less is more” to low back pain. Arch Intern Med. 2012;172(13):1016-20. https://doi.org/10.1001/archinternmed.2012.1838 https://pubmed.ncbi.nlm.nih.gov/22664775

Modic MT, Obuchowski NA, Ross JS, Brant-Zawadzki MN, Grooff PN, Mazanec DJ, et al. Acute low back pain and radiculopathy: MR imaging findings and their prognostic role and effect on outcome. Radiology. 2005;237(2):597-604. https://doi.org/10.1148/radiol.2372041509 https://pubmed.ncbi.nlm.nih.gov/16244269

Franz EW, Bentley JN, Yee PP, Chang KW, Kendall-Thomas J, Park P, et al. Patient misconceptions concerning lumbar spondylosis diagnosis and treatment. J Neurosurg Spine. 2015;22(5):496-502. https://doi.org/10.3171/2014.10.SPINE14537 https://pubmed.ncbi.nlm.nih.gov/25723120

Zakon o varstvu pred ionizirajočimi sevanji in jedrski varnosti (ZVISJV-1). Uradni list RS. 2017(76).

Zakon o pacientovih pravicah (ZPacP). Uradni list RS. 2008(15).

Mettler FA, Huda W, Yoshizumi TT, Mahesh M. Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology. 2008;248(1):254-63. https://doi.org/10.1148/radiol.2481071451 https://pubmed.ncbi.nlm.nih.gov/18566177

Espeland A, Baerheim A, Albrektsen G, Korsbrekke K, Larsen JL. Patients’ views on importance and usefulness of plain radiography for low back pain. Spine. 2001;26(12):1356-63. https://doi.org/10.1097/00007632-200106150-00020 https://pubmed.ncbi.nlm.nih.gov/11426152

Stivaros SM, Gledson A, Nenadic G, Zeng XJ, Keane J, Jackson A. Decision support systems for clinical radiological practice— towards the next generation. Br J Radiol. 2010;83(995):904-14. https://doi.org/10.1259/bjr/33620087 https://pubmed.ncbi.nlm.nih.gov/20965900

Navodilo o beleženju in obračunavanju zdravstvenih storitev in izdanih materialov. Zavod za zdravstveno zavarovanje Slovenije. [cited 2018 Aug 26]. Available from: https://partner.zzzs.si/wps/portal/portali/aizv/belezenje_obracun_zdr_storitev_izd.materialov_okroznice_zae

Published
2020-03-10
How to Cite
1.
Staparski Dobravec S, Kumše Gale Z, Makivić I. Can consultation between the radiologist and patients contribute to reducing unnecessary radiological examinations?. ZdravVestn [Internet]. 10Mar.2020 [cited 6Apr.2020];89(1-2):3-1. Available from: https://vestnik.szd.si/index.php/ZdravVest/article/view/2881
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