title: Chest radiography in general practice: indications, diagnostic yield and consequences for patient management.
abstract: BACKGROUND
  Chest radiography (CXR) is frequently performed in Western societies. There is insufficient knowledge of its diagnostic value in terms of changes in patient management decisions in primary care.
  
  
  OBJECTIVE
  To assess the influence of CXR on patient management in general practice.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Seventy-eight GPs and three general hospitals in the Netherlands.
  
  
  METHODS
  Patients (n = 792) aged > or =18 years referred by their GPs for CXR were included. The main outcome was change in patient management assessed by means of questionnaires filled in by GPs before and after CXR.
  
  
  RESULTS
  Mean age of the patients was 57.3+/-16.2 years and 53% were male. Clinically relevant abnormalities were found in 24% of the CXRs. Patient management changed in 60% of the patients following CXR. Main changes included: fewer referrals to a medical specialist (from 26 to 12%); reduction in initiation or change in therapy (from 24 to 15%); and more frequent reassurance (from 25 to 46%). However, this reassurance was not perceived as such in a quarter of these patients. A change in patient management occurred significantly more frequently in patients with complaints of cough (67%), those who exhibited abnormalities during physical examination (69%), or those with a suspected diagnosis of pneumonia (68%).
  
  
  CONCLUSIONS
  Patient management by the GP changed in 60% of patients following CXR. CXR substantially reduced the number of referrals and initiation or change in therapy, and more patients were reassured by their GP. Thus, CXR is an important diagnostic tool for GPs and seems a cost-effective diagnostic test.
authors.affiliation: Department of Radiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Anouk M
authors.initials: AM
authors.lastname: Speets
authors.forename: Yolanda
authors.initials: Y
authors.lastname: van der Graaf
authors.forename: Arno W
authors.initials: AW
authors.lastname: Hoes
authors.forename: Sandra
authors.initials: S
authors.lastname: Kalmijn
authors.forename: Alfred Pe
authors.initials: AP
authors.lastname: Sachs
authors.forename: Matthieu Jcm
authors.initials: MJ
authors.lastname: Rutten
authors.forename: Jan Willem C
authors.initials: JW
authors.lastname: Gratama
authors.forename: Alexander D
authors.initials: AD
authors.lastname: Montauban van Swijndregt
authors.forename: Willem Pthm
authors.initials: WP
authors.lastname: Mali
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics; D005194:Family Practice / Q000191:economics; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000000981:diagnostic imaging* / Q000191:economics / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011446:Prospective Studies; D013902:Radiography, Thoracic / Q000191:economics / Q000706:statistics & numerical data*; D012017:Referral and Consultation