Variation in requests for imaging investigations by general practitioners: A multilevel analysis

Verstappen, Wim; Riet, Gerben ter; Weijden, Trudy van der; Hermsen, Jan; Grol, Richard

doi:10.1177/135581960501000107

Cited by 8 publications

(5 citation statements)

References 22 publications

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“…Previous studies have focused on selected factors' impact on use of radiology [ 9 , 11 , 19 , 29 , 30 ], or were restricted to clinicians' point of view [ 12 , 14 ]. This study gives new information by suggesting how the diversity of causal factors may be ranked and interrelated, and by presenting the radiologists' perspective.…”

Section: Discussionmentioning

confidence: 99%

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

Lysdahl

Hofmann

2009

BMC Health Serv Res

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Background: 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.

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Section: Discussionmentioning

confidence: 99%

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

Lysdahl

Hofmann

2009

BMC Health Serv Res

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“…Many studies have analysed how GP, practice, patient and structural characteristics affect clinical performance, including referral rates [18], imaging investigations [19] and other procedures, tests and follow-ups [20]. However, these studies have been able to explain only a small part of the observed variation in the length of delay.…”

Section: Introductionmentioning

confidence: 99%

General practitioner characteristics and delay in cancer diagnosis. a population-based cohort study

et al. 2011

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BackgroundDelay in cancer diagnosis may have serious prognostic consequences, and some patients experience delays lasting several months. However, we have no knowledge whether such delays are associated with general practitioner (GP) characteristics. The aim of the present study was to analyse whether GP and practice characteristics are associated with the length of delay in cancer diagnosis.MethodsThe study was designed as a population-based cohort study. The setting was the County of Aarhus, Denmark (640,000 inhabitants). Participants include 334 GPs and their 1,525 consecutive, newly diagnosed cancer patients. During one year (September 2004 to August 2005), patients with incident cancer were enrolled from administrative registries. GPs completed questionnaires on the patients' diagnostic pathways and on GP and practice characteristics. Delay was categorised as patient-related (more than 60 days), doctor-related (more than 30 days) and system-related (more than 90 days). The associations between delay and characteristics were assessed in a logistic regression model using odds ratios (ORs).ResultsNo GP characteristics (seniority, practice organization, list size, participation in continuing medical education, job satisfaction and level of burnout) were associated with doctor delay. Patients of female GPs more often had a short patient delay than patients of male GPs (OR 0.44, 95% confidence interval (95%CI) 0.28 to 0.71). Patients whose GPs provided many services (OR 0.66, 95%CI 0.44 to 0.95) and patients attending GPs with little former knowledge of their patients (OR 0.68, 95%CI 0.47 to 0.99) more often experienced a short system delay than patients attending GPs with less activity and more knowledge of their patients. Patients listed with a female GP more often experienced a long system delay than patients of male GPs (OR 1.50, 95%CI 1.02 to 2.21). Finally, patients with low GP-reported compliance more often experienced a long system delay (OR 1.73, 95%CI 1.07 to 2.80) than patients with higher compliance.ConclusionsGP characteristics were not statistically significantly associated with doctor delay. However, some GP characteristics were associated with patient and system delay, which indicates that these factors may be important for understanding patient delay (e.g. perceived GP accessibility and the GP-patient relationship) and system delay (e.g. the GP's experience and opportunities for referring and coordinating diagnostic work-up).

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“…However, a number of studies have not documented a relationship between the age of GPs and their referral rates. 18–20 It could also be that older GPs were educated at a time when making a definite diagnosis was deemed to be high-quality care. In contrast, today’s education in family medicine might give younger GPs a more realistic impression of the diagnostic process of cancer in general practice.…”

Section: Discussionmentioning

confidence: 99%

“…However, a number of studies have not documented a relationship between the age of GPs and their referral rates. [18][19][20] It could also be that older GPs Table 3. Linear regression analyses (adjusted for sex and age of GP and for GPs working in the same practice).…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

General practitioners’ anticipated risk of cancer at referral and their attitude to risk taking and to their role as gatekeeper

Pedersen

Vedsted

2015

J Health Serv Res Policy

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Variation in requests for imaging investigations by general practitioners: A multilevel analysis

Cited by 8 publications

References 22 publications

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

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

General practitioner characteristics and delay in cancer diagnosis. a population-based cohort study

General practitioners’ anticipated risk of cancer at referral and their attitude to risk taking and to their role as gatekeeper

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