Background
: MRI is a new and expensive diagnostic technology, which has been used increasingly
all over the world. Low back pain is a worldwide prevalent disorder and MRI technique is one of
the several ways to diagnose it. This paper aims to identify the appropriateness of lumbar spine
MRI prescriptions in Shiraz teaching hospitals using standardized R AND Appropriateness Method
(R AM) criteria in 2012.
Methods
: This study consisted of two phases. The first phase involved a qualitative enquiry and
the second phase had a quantitative cross-sectional nature. In the first phase RAM was used
for developing lumbar spine MRI indications and scenarios. In the second phase, the finalized
scenarios were compared with the history and physical examination of 300 patients with low back
pain. The rate of appropriateness of lumbar spine MRI prescription was then calculated.
Results
: Of 300 cases of lumbar spine MRI prescriptions, approximately 167 (56%) were
considered inappropriate, 72 (24%) were uncertain, and 61 (20%) were deemed to be appropriate.
The economic burden of inappropriate prescriptions was calculated at 88,009,000 Rials. In
addition, the types of expertise and physical examination were considered as related factors to
appropriateness of prescriptions.
Conclusion
: In conclusion, a large proportion of lumbar spine MRI prescriptions, which result in
financial burden on the insurance companies and the patients alike is unnecessary. This study
suggests that policy makers consider this evidence while decision-making. Our findings highlight
the imperative role of Health Technology Assessment (HTA) and Clinical Practice Guidelines (CPGs).
As a result, developing local clinical guidelines may create the commitment needed in physicians
in prescribing appropriate prescriptions within the health sector. The study further recommends
that appropriate scenarios should be considered as a criterion for payment and reimbursement
