title: "Chasing a Ghost": Factors that Influence Primary Care Physicians to Follow Up on Incidental Imaging Findings.
abstract: Purpose To explore provider and patient characteristics that influence how primary care providers (PCPs) communicate and manage incidental imaging findings. Materials and Methods This HIPAA-compliant study was approved by the institutional review board. Through semistructured interviews, researchers explored concerns and perspectives of 30 PCPs on receiving and acting on incidental imaging findings. Open-ended questions were designed to elicit a range of responses rather than quantifiable data. Thematic codes were developed and explicitly defined. Three research assistants independently coded all 30 deidentified transcripts and resolved discrepancies (κ = 0.85). Codes pertaining to PCP and patient characteristics were organized into an explanatory model. Results Some PCPs felt compelled but frustrated to pursue costly follow-up for incidental imaging findings of limited clinical importance. Other PCPs did not act on findings that were unfamiliar or occurred in an unusual clinical context when follow-up recommendations were not given; the challenges of researching the clinical importance of these findings or seeking specialist consultation led to inaction. Some PCPs reported using a uniform approach to communicate and manage incidental findings, while others adapted their approach to the patient and the finding. Sometimes PCP characteristics such as follow-up style superseded patient characteristics. At other times patient characteristics such as health literacy superseded PCP characteristics. Conclusion PCPs cited a variety of objective and subjective factors that influence how they communicate and manage incidental imaging findings. These results suggest that some patients may receive inappropriate follow-up of incidental imaging findings and present an opportunity for radiologists to help PCPs and patients to best use the information conveyed in imaging reports.©RSNA, 2016 Online supplemental material is available for this article.
authors.affiliation: From the Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (H.M.Z.); Leonard Davis Institute of Health Economics (H.M.Z.) and Center for Public Health Initiatives, School of Social Policy and Practice (R.F.), University of Pennsylvania, Philadelphia, Pa; Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.K.B.); and Departments of Radiology and Medicine, Stanford University School of Medicine, Stanford, Calif (C.P.L.).
authors.forename: Hanna M
authors.initials: HM
authors.lastname: Zafar
authors.affiliation: From the Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (H.M.Z.); Leonard Davis Institute of Health Economics (H.M.Z.) and Center for Public Health Initiatives, School of Social Policy and Practice (R.F.), University of Pennsylvania, Philadelphia, Pa; Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.K.B.); and Departments of Radiology and Medicine, Stanford University School of Medicine, Stanford, Calif (C.P.L.).
authors.forename: Eva K
authors.initials: EK
authors.lastname: Bugos
authors.affiliation: From the Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (H.M.Z.); Leonard Davis Institute of Health Economics (H.M.Z.) and Center for Public Health Initiatives, School of Social Policy and Practice (R.F.), University of Pennsylvania, Philadelphia, Pa; Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.K.B.); and Departments of Radiology and Medicine, Stanford University School of Medicine, Stanford, Calif (C.P.L.).
authors.forename: Curtis P
authors.initials: CP
authors.lastname: Langlotz
authors.affiliation: From the Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (H.M.Z.); Leonard Davis Institute of Health Economics (H.M.Z.) and Center for Public Health Initiatives, School of Social Policy and Practice (R.F.), University of Pennsylvania, Philadelphia, Pa; Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.K.B.); and Departments of Radiology and Medicine, Stanford University School of Medicine, Stanford, Calif (C.P.L.).
authors.forename: Rosemary
authors.initials: R
authors.lastname: Frasso
mesh_terms: D000328:Adult; D003266:Continuity of Patient Care; D003952:Diagnostic Imaging; D019468:Disease Management; D005260:Female; D006801:Humans; D033162:Incidental Findings; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D058007:Physicians, Primary Care