Effectiveness of GP access to magnetic resonance imaging of the knee: a randomised trial

Team, Damask Trial

doi:10.3399/bjgp08x342651

“…10 Specialists, however, caution that capacity for secondary care investigation is limited and that DA leads to overinvestigation without increased diagnostic yield. 11 Conversely, GP reluctance to take on responsibility for investigation has been demonstrated in the contexts of knee imaging and infertility, 12,13 and GPs often fail to employ diagnostic tests for cancer despite having DA to them. 14 The UK Department of Health invested £200m in 2012 to enhance GP access to four diagnostic tests for cancer as part of its commitment to save 10 000 lives lost due to late cancer diagnosis by 2015.…”

Section: Introductionmentioning

confidence: 99%

Direct access cancer testing in primary care: a systematic review of use and clinical outcomes

Smith

¹

,

Tompson

²

,

Jones

³

et al. 2018

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“…The DAMASK (Direct Access to Magnetic Resonance Imaging: Assessment for Suspect Knees) trial assessed the effectiveness of GP referral to early MRI and a provisional orthopaedic appointment, compared with referral to an orthopaedic specialist without prior MRI for patients with continuing knee problems over a 2-year period, for 553 patients recruited from 163 general practices. 14 The authors suggest increased GP diagnostic and therapeutic confidence because of imaging access. However, they state access to MRI did not influence GP decisions for specialist referral post-imaging, based…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

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

Kara

¹

,

Smart

²

,

Officer

³

et al. 2019

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INTRODUCTIONMagnetic 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. AIMTo 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. METHODSThis 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. RESULTSIn 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. DISCUSSIONStudy 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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“…The DAMASK (Direct Access to Magnetic Resonance Imaging: Assessment for Suspect Knees) trial assessed the effectiveness of GP referral to early MRI and a provisional orthopaedic appointment, compared with referral to an orthopaedic specialist without prior MRI for patients with continuing knee problems over a 2-year period, for 553 patients recruited from 163 general practices. 14 The authors suggest increased GP diagnostic and therapeutic confidence because of imaging access. However, they state access to MRI did not influence GP decisions for specialist referral post-imaging, based ORIGINAL RESEARCH PAPER ORIGINAL RESEARCH: HEALTH SERVICES on the fact that only 10% of patients having prebooked specialist appointments were cancelled by their GPs; this was used as a surrogate marker to support no change in GP referral patterns.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

“…Over the past 20 years, as part of a drive to manage patient journeys more efficiently and to improve use of health system resources, several countries have trialled direct access MRI referrals. 8,10,13,14 This paper reports on the New Zealand experience of direct access MRI, specifically focusing on whether pre-training and quality assurance frameworks can lead to appropriate GP access to deliver suitable patient management outcomes. Given uncertainty around introducing earlier GP access to funded MRI, the primary aim of this study was to examine whether a decision support framework of guidelines, training and quality assurance resulted in clinically appropriate use of MRI.…”

Section: Introductionmentioning

confidence: 99%

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

Kara¹,

Smart²,

Officer³

et al. 2019

J Prim Health Care

0

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INTRODUCTIONMagnetic 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. AIMTo 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. METHODSThis 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. RESULTSIn 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. DISCUSSIONStudy 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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Effectiveness of GP access to magnetic resonance imaging of the knee: a randomised trial

Cited by 27 publications

References 29 publications

Direct access cancer testing in primary care: a systematic review of use and clinical outcomes

Direct access cancer testing in primary care: a systematic review of use and clinical outcomes

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

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

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