Physicians perceived usefulness of high-cost diagnostic imaging studies: results of a referral study in a German medical quality network.
BACKGROUND
Medical and technological progress has led to increased numbers of diagnostic tests, some of them inducing high financial costs. In Germany, high-cost diagnostic imaging is performed by a medical specialist after referral by a general practitioner (GP) or specialist in primary care. The aim of this study was to evaluate the physicians' perceived usefulness of high-cost diagnostic imaging in patients with different clinical conditions.


METHODS
Thirty-four GPs, one neurologist and one orthopaedic specialist in ambulatory care from a Medical Quality Network documented 234 referrals concerning 97 MRIs, 96 CTs-scan and 41 intracardiac catheters in a three month period. After having received the test results, they indicated if these were useful for diagnosis and treatment of the patient.


RESULTS
The physicians' perceived usefulness of tests was lowest in suspected cerebral disease (40% of test results were seen as useful), cervical spine problems (64%) and unexplained abdominal complaints (67%). The perceived usefulness was highest in musculoskeletal symptoms (94%) and second best in cardiological diseases (82%).


CONCLUSIONS
The perceived usefulness of high-cost diagnostic imaging was lower in unexplained complaints than in specific diseases. Interventions to improve the effectiveness and efficiency of test ordering should focus on clinical decision making in conditions where GPs perceived low usefulness.
Schneider
Antonius
A
Department of General Practice and Health Services Research, University of Heidelberg. antonius.schneider@med.uni-heidelberg.de
Rosemann
Thomas
T
Wensing
Michel
M
Szecsenyi
Joachim
J
D000368:Aged; D001291:Attitude of Health Personnel; D006328:Cardiac Catheterization / Q000191:economics* / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D003952:Diagnostic Imaging / Q000191:economics* / Q000706:statistics & numerical data; D005194:Family Practice / Q000191:economics* / Q000592:standards; D005260:Female; D005858:Germany; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009462:Neurology / Q000191:economics* / Q000592:standards; D009985:Orthopedics / Q000191:economics* / Q000592:standards; D017063:Outcome Assessment, Health Care / Q000191:economics* / Q000379:methods; D011237:Predictive Value of Tests; D011785:Quality Assurance, Health Care; D012017:Referral and Consultation; D013675:Technology, High-Cost / Q000191:economics / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000706:statistics & numerical data