Guidelines, training and quality assurance: influence on general practitioner MRI referral quality.

Autor:	Kara, Stephen, Smart, Alexandra, Officer, Tara, Dassanayake, Chan, Clark, Phil, Smit, Amy, Cavadino, Alana
Předmět:	MUSCULOSKELETAL system injuries CONFIDENCE intervals DECISION making FISHER exact test MAGNETIC resonance imaging MEDICAL education MEDICAL protocols MEDICAL referrals MEDICAL specialties & specialists SCIENTIFIC observation QUALITY assurance RESEARCH funding STATISTICS LOGISTIC regression analysis PROFESSIONAL practice INTER-observer reliability RETROSPECTIVE studies DATA analysis software ODDS ratio
Zdroj:	Journal of Primary Health Care; Sep2019, Vol. 11 Issue 3, p235-242, 8p
Abstrakt:	INTRODUCTION: Magnetic resonance imaging (MRI) is an accurate diagnostic test used mainly in secondary care. Uncertainty exists regarding the ability of general practitioners (GPs) to use direct access high-tech imaging pathways appropriately when managing musculoskeletal injury. AIM: To evaluate the use of primary care-centric guidelines, training and quality assurance on the appropriateness of GP MRI referrals for patients with selected musculoskeletal injuries. METHODS: This is an 18-month primary care retrospective study. GPs participated in clinical musculoskeletal training, enabling patient referral for MRI on four body sites. Two reviewers categorised referral appropriateness independently, and reviewer inter-rater agreement between categorisations was measured. MRI results and patient management pathways were described. Associations of scan status and patient management were examined using logistic regression. RESULTS: In total, 273 GPs from 72 practices attended training sessions to receive MRI referral accreditation. Of these, 150 (55%) GPs requested 550 MRI scans, with 527 (96%) eligible for analysis, resulting in 86% considered appropriate; 79% consistent with guidelines and 7% clinically useful but for conditions outside of guidelines. Inter-rater agreement was 75%. Cohen's weighted kappa statistic was 0.38 (95% CI: 0.28–0.48). MRI referrals consistent with guidelines were more likely to show pathology requiring specialist intervention (reviewer 1: odds ratio = 2.64, 95% CI 1.51–4.62; reviewer 2: odds ratio = 4.44, 95% CI 2.47–7.99), compared to scan requests graded not consistent. DISCUSSION: Study findings indicate GPs use decision support guidance well, and this has resulted in appropriate MRI referrals and higher specialist intervention rates for selected conditions. [ABSTRACT FROM AUTHOR]
Databáze:	Complementary Index
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