Which Factors Determine the Use of Diagnostic Imaging Technologies for Gastrointestinal Complaints in General Medical Practice?

Abstract

Objective: Even though gastrointestinal complaints are among the most frequent reasons to contact general medical practioners, little is known about the actual care of these patients, especially the use of diagnostic imaging technologies.Methods: In a network of 57 family practitioners and 29 general internists in Lower Saxony, Germany, 1,217 contacts with patients with gastrointestinal diseases (16%, gastritis; 12%, gastroenteritis; 6%, cholelithiasis; 5% each, ulcus ventriculi and duodeni, and 14%, no final diagnosis) were documented. The effects of patient and physician/practice side factors on the use of ultrasonography and radiography were modeled using multivariate logistic regression.Results: For ultrasonography, diagnosis and ownership of an ultrasound unit (odds ratio [OR] = 3.33) were highly significant predictors (p < .0001), followed by unknown diagnosis at beginning of contact (OR = 1.92; p = .0019), physician specialty (OR for internists = 1.89; p = .0025), and severity (p = .0085). For radiography, ownership of an ultrasound unit was the most significant factor (OR = 0.34; p < .0001), followed by severity (p < .0009), ownership of x-ray apparatus (OR = 2.56; p = .0025), physician specialty (OR for internists = 1.98; p = .0358), and unknown diagnosis at beginning of contact (OR = 1.79; p = .0451). Not significant were age and sex of patient and diagnosis for radiography.Conclusions: Physicians use diagnostic imaging technologies for patients with gastrointestinal complaints according to severity and knowledge about the diagnosis, but ownership of technology is the most predictive factor.

Effects of a fixed-payment method on demand for imaging tests in a university hospital

“…This result is consistent with those of previous studies that compared the effects of various payment methods. 13,17,18 Our results also indicate that the decreased demand FIX-PAYMENT AND DEMAND OF IMAGING TESTS observed after implementation of the fixed-payment method was not the result of changes in supplier-induced demand.…”

“…1,3,4,9 It was previously reported that 'the most egregious cause of inappropriate use arises when an ordering physician has a financial interest in the entity performing the examination', 9 and previous studies indicated that ownership of a technology is an important factor in overuse. 3,13 In various nations, an estimated 10 2 30% of the imaging tests ordered are unnecessary. 14 In Turkey, a previous study reported substantial inappropriate hospital utilization (24.6 2 34.2%) in two major hospitals.…”

“…Our findings indicate that financial regulation decreases the demand for imaging tests, consistent with the results of previous studies. 3,9,13,16 This decrease may result from a strong financial relationship between hospital personnel and the hospital, in that some of the hospital revenue, which can be increased by eliminating unnecessary tests, came back to health personnel as incentives. These results demonstrate that financial incentive for hospital personnel is an important factor in the demand for imaging tests.…”

Effects of a fixed-payment method on demand for imaging tests in a university hospital

“…This result is consistent with those of previous studies that compared the effects of various payment methods. 13,17,18 Our results also indicate that the decreased demand FIX-PAYMENT AND DEMAND OF IMAGING TESTS observed after implementation of the fixed-payment method was not the result of changes in supplier-induced demand.…”

“…1,3,4,9 It was previously reported that 'the most egregious cause of inappropriate use arises when an ordering physician has a financial interest in the entity performing the examination', 9 and previous studies indicated that ownership of a technology is an important factor in overuse. 3,13 In various nations, an estimated 10 2 30% of the imaging tests ordered are unnecessary. 14 In Turkey, a previous study reported substantial inappropriate hospital utilization (24.6 2 34.2%) in two major hospitals.…”

“…Our findings indicate that financial regulation decreases the demand for imaging tests, consistent with the results of previous studies. 3,9,13,16 This decrease may result from a strong financial relationship between hospital personnel and the hospital, in that some of the hospital revenue, which can be increased by eliminating unnecessary tests, came back to health personnel as incentives. These results demonstrate that financial incentive for hospital personnel is an important factor in the demand for imaging tests.…”

Effects of a fixed-payment method on demand for imaging tests in a university hospital

“…This result is consistent with those of previous studies that compared the effects of various payment methods. 13,17,18 Our results also indicate that the decreased demand FIX-PAYMENT AND DEMAND OF IMAGING TESTS observed after implementation of the fixed-payment method was not the result of changes in supplier-induced demand.…”

“…1,3,4,9 It was previously reported that 'the most egregious cause of inappropriate use arises when an ordering physician has a financial interest in the entity performing the examination', 9 and previous studies indicated that ownership of a technology is an important factor in overuse. 3,13 In various nations, an estimated 10 2 30% of the imaging tests ordered are unnecessary. 14 In Turkey, a previous study reported substantial inappropriate hospital utilization (24.6 2 34.2%) in two major hospitals.…”

“…Our findings indicate that financial regulation decreases the demand for imaging tests, consistent with the results of previous studies. 3,9,13,16 This decrease may result from a strong financial relationship between hospital personnel and the hospital, in that some of the hospital revenue, which can be increased by eliminating unnecessary tests, came back to health personnel as incentives. These results demonstrate that financial incentive for hospital personnel is an important factor in the demand for imaging tests.…”

Effects of a fixed-payment method on demand for imaging tests in a university hospital

“…This result is consistent with those of previous studies that compared the effects of various payment methods. 13,17,18 Our results also indicate that the decreased demand FIX-PAYMENT AND DEMAND OF IMAGING TESTS observed after implementation of the fixed-payment method was not the result of changes in supplier-induced demand.…”

“…1,3,4,9 It was previously reported that 'the most egregious cause of inappropriate use arises when an ordering physician has a financial interest in the entity performing the examination', 9 and previous studies indicated that ownership of a technology is an important factor in overuse. 3,13 In various nations, an estimated 10 2 30% of the imaging tests ordered are unnecessary. 14 In Turkey, a previous study reported substantial inappropriate hospital utilization (24.6 2 34.2%) in two major hospitals.…”

“…Our findings indicate that financial regulation decreases the demand for imaging tests, consistent with the results of previous studies. 3,9,13,16 This decrease may result from a strong financial relationship between hospital personnel and the hospital, in that some of the hospital revenue, which can be increased by eliminating unnecessary tests, came back to health personnel as incentives. These results demonstrate that financial incentive for hospital personnel is an important factor in the demand for imaging tests.…”