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Cited by 6Radiology practices and educationMusculoskeletal Disorders and RehabilitationHealthcare cost, quality, practices

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

Open access
Kara, Stephen, Smart, Alexandra, Officer, Tara, Dassanayake, Chan, Clark, Phil, Smit, Amy, Cavadino, Alana·2019·The Journal of Primary Health Care
DOI 10.1071/hc19034
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Abstract

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.

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  • General practitioners frequently perform cognitive screening with or without directly ordering MRI tests, whereas memory specialists typically expand testing batteries to include imaging and advanced neuropsychological testing.

    “For example, GPs frequently perform cognitive screening with or without directly ordering MRI tests28–30, whereas memory specialists typically expand testing batteries to include imaging and advanced neuropsychological testing.”

    From Multimodal deep learning for Alzheimer's disease dementia assessment (2022) · cites this paper as [29]

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Authors
Kara, S., Smart, A., Officer, T., Dassanayake, C., Clark, P., Smit, A., & Cavadino, A.
Affiliations
  • AProCare PHO, Level 2/110 Stanley St, Grafton, Auckland 1143, New Zealand
  • Victoria University of Wellington (NZ)
  • Health New Zealand (NZ)
  • Mercy Hospital (NZ)
  • University of Auckland (NZ)
Corresponding author
Kara, Stephen
ORCID
Venue
The Journal of Primary Health Care
Publisher
CSIRO Publishing
Published
2019-09-30
Volume
11
Issue
3
Pages
235-242
ISSN
1172-6156 (ISSN-L)
DOI
10.1071/hc19034
OpenAlex
W2978353800
Cited by
6
References
21
Citations by year
2026: 1 · 2025: 2 · 2022: 2 · 2019: 1
FWCI
0.50
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Primary Health Care (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiology practices and education
  • Health Sciences › Medicine › Rehabilitation › Musculoskeletal Disorders and Rehabilitation
  • Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
Keywords
general practitioners, musculoskeletal injuries, clinical guidelines, clinical teaching, quality assurance, decision support, interobserver agreement, primary care
MeSH terms
Adolescent, Adult, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Musculoskeletal System, Quality Assurance, Health Care, Referral and Consultation, Retrospective Studies, Treatment Outcome, Practice Guidelines as Topic, Unnecessary Procedures, Young Adult, General Practitioners

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