Family Practice, Vol 15, 236-243, Copyright © 1998 by World Organization of Family Doctors
M Robling, P Kinnersley, H Houston, M Hourihan, D Cohen and J Hale
BACKGROUND: Direct access to Magnetic Resonance Imaging (MRI) is becoming
available to GPs in the UK, offering major benefits for the improved
diagnosis and management of certain clinical conditions. Variations in
usage of this service may be large, and effective locally produced
guidelines are not currently available. The Department of General Practice
is conducting a research programme to develop and evaluate methods to
optimize MRI use by GPs. OBJECTIVES: We aimed to describe the current use
of MRI by GPs in South Glamorgan; to summarize their reasons for requesting
MRI; and to produce criteria to assess the appropriateness of magnetic
resonance (MR) scan requests. METHODS: Using the critical incident
technique, 25 GPs were interviewed about recent scans requested for
patients with knee and lumbar spine complaints. A local panel of primary
and secondary care doctors was convened to develop criteria for assessing
MR scan requests. RESULTS: Sixty-two scan requests were discussed. Doctors'
reasons for requesting MR scans were identified and classified. Reasons for
requests included personal, contextual and biomedical variables. Fifteen
patients (24%) were managed in primary care following MRI when otherwise
they would have been referred. When referrals were made, GPs felt able to
reinforce the request and occasionally to direct the patient somewhere more
appropriate. The panel reviewed the interview data to produce objective
criteria to assess scan requests. The criteria reflect the relative
importance of non-biomedical variables in the decision to request MRI.
CONCLUSION: The study identified those reasons which are important to GPs
when requesting MR scans and the impact of this new technology upon patient
management. Interview data have been used to inform locally developed
consensus criteria, which will be made available as practice guidelines as
the research programme progresses.
ORIGINAL CLINICAL RESEARCH
An exploration of GPs' use of MRI: a critical incident study
Department of General Practice, University of Wales College of Medicine, Llanedeyrn Health Centre, Cardiff, UK.
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