What causes increasing and unnecessary use of radiological investigations? a survey of radiologists' perceptions

<p>Abstract</p> <p>Background</p> <p>Growth in use and overuse of diagnostic imaging significantly impacts the quality and costs of health care services. What are the modifiable factors for increasing and unnecessary use of radiological services? Various factors have been indentified, but little is known about their relative impact. Radiologists hold key positions for providing such knowledge. Therefore the purpose of this study was to obtain radiologists' perspective on the causes of increasing and unnecessary use of radiological investigations.</p> <p>Methods</p> <p>In a mailed questionnaire radiologist members of the Norwegian Medical Association were asked to rate potential causes of increased investigation volume (fifteen items) and unnecessary investigations (six items), using five-point-scales. Responses were analysed by using summary statistics and Factor Analysis. Associations between variables were determined using Students' t-test, Spearman rank correlation and Chi-Square tests.</p> <p>Results</p> <p>The response rate was 70% (374/537). The highest rated causes of increasing use of radiological investigations were: a) new radiological technology, b) peoples' demands, c) clinicians' intolerance for uncertainty, d) expanded clinical indications, and e) availability. 'Over-investigation' and 'insufficient referral information' were reported the most frequent causes of unnecessary investigations. Correlations between causes of increasing and unnecessary radiology use were identified.</p> <p>Conclusion</p> <p>In order to manage the growth in radiological imaging and curtail inappropriate investigations, the study findings point to measures that influence the supply and demand of services, specifically to support the decision-making process of physicians.</p

Utilization and utility of diagnostic imaging : Quantitative studies and normative considerations

Today the practice of most medical disciplines is almost unrecognisable without modern radiology. Imaging technology is fascinating, is developing rapidly, and is without doubt beneficial, but there are also concerns about over-utilization, the risks of harm and the costs involved. The overall aim of this dissertation is to improve our understanding of utilization of radiological services, by investigating aspects of the actual use and as perceived by the radiologist. Further, the aim is to illuminate utility issues based on empirical research. The utilization of imaging was investigated through two quantitative surveys. We collected activity data from all radiology institutions in Norway in order to estimate the frequency of radiological examinations. A questionnaire was mailed to Norwegian radiologists to obtain information about their perceptions, actions and reasoning regarding utilization of imaging. We found a significant increase in utilization of diagnostic imaging, especially MRI and CT examinations, leading to a relatively high increase in the collective effective dose. We found that geographical variation in examination frequency was highest for these newer technologies. Accessibility is a likely explanation for both the increase in utilization over time and the geographical variation. According to the radiologists, the major causes of increasing utilization were related to ‘supply and demand’ mechanisms, like expanded technological and medical possibilities, availability of services, and the demands of people and referring clinicians for assurance. They consider over-utilization to comfort patients and clinicians to be the main cause of unnecessary examinations, followed by insufficient referral information. Almost all radiologists reported that they frequently took action in response to inadequate referrals, mainly by contacting the clinician and by checking the medical records. Such actions were primarily motivated by patient safety considerations (risk of complications, radiation dose and low patient age), while somewhat hindered by respect for the judgment of the referrer, the wishes of the patient and practical obstacles. The empirical findings indicate benefits of increasing utilization of imaging in the shape of improved health outcome, reduced pain and lower costs, but also lack of such benefits and possible harm. The overall usefulness of increased utilization can be considered to be limited from a utilitarian perspective. Norms and measures to manage utilization of imaging initiated by the professionals are those that should have the highest potential for increasing the utility of services. Key elements of such measures should be clinical guidelines, giving radiologists more discretionary power, and critical assessment of referrals