Radiology in the era of value-based healthcare: A multi-society expert statement from the ACR, CAR, ESR, IS3R, RANZCR and RSNA

Irish general practitioner (GP) perspectives on impact of direct access radiology on patient care in the community: results from a mixed-methods study

BACKGROUND

Since winter 2020/21, general practitioners (GPs) in the Republic of Ireland (RoI) have been granted access to diagnostic imaging studies on a new publicly funded pathway, expediting access to services previously obtained via hospital-based doctors.

AIMS

Outline GP perspectives on imaging studies obtained via the new "GP Access to Community Diagnostics" initiative.

METHODS

A mixed-methods design was employed. Referrals over the first six months of 2019 and 2021 were collated by a private imaging provider, and a randomly selected subset of 2021 studies (maximum 30 referrals per GP) was returned to participating GPs to provide detail on the impact on each patient's care. In-depth qualitative interviews were also conducted with participating GPs.

RESULTS

Eleven GPs supplied detailed information on 81 studies organized through the new initiative. GPs reported that the initiative had led to a large proportion of cases being managed solely in general practice, with an 81% reduction in referrals to acute hospital settings and a 58% reduction in referrals to secondary care clinics. GPs felt imaging studies improved patient care in 86% of cases and increased GP workload in 58% of cases. GP qualitative interviews revealed four key themes: improved patient care, increased GP workload, reduction in hospital referrals, and opinions on ongoing management of such initiatives, including guidelines.

CONCLUSIONS

GPs felt enhancing access to diagnostics improved patient care by expediting diagnosis, decision-making, and treatment and by reducing hospital referrals. GPs were generally positive about the initiative and made some suggestions on future management of the initiative.

Radiography-An etymological and semantic concept analysis from the perspective of radiographic science

INTRODUCTION

Concepts are cornerstones in science, and their determination is a prerequisite for understanding their substance and meaning. Radiography as a concept is not straightforward nor simple to understand, and there are different interpretations depending on the scientific perspective. To develop truthful knowledge of radiography from the perspective of the discipline, a determination of the subject and substance of radiography is required and thereby is a precursor for theory development. The aim of this study was to investigate the etymological and semantic meaning of radiography from the radiography science perspective.

METHODS

An etymological and semantic analysis has been applied according to Koort and Eriksson's theoretical model. Dictionaries published between 2004 and 2021 were used.

RESULTS

The findings show that etymologically, radiography is formed by compounding the words 'radio' and 'graphy', originating historically from Latin and Greek. The semantic analysis revealed that the substance of radiography consisted of four characteristics that are the basic substance of radiography. The characteristics were X-ray and radiation, human beings-opaque objects, process including an act and art and images.

CONCLUSION

This study clarifies the substance and meaning of radiography as a subject from the perspective of radiography science. The subject and substance consisted of the four basic characteristics that all are vital and required to understand the concept of radiography. The characteristics revealed that radiography science is based on scientific knowledge and carrier of properties of meaning that provide a fundamental understanding of radiography science.

IMPLICATIONS FOR PRACTICE

Investigating the subject, substance and meaning of radiography as a concept can become the base for further theoretical, contextual and practical understanding and support in the development of theory in radiography science.

Evidence-based funding of new imaging applications and technologies by Medicare in Australia: How it happens and how it can be improved

BACKGROUND

The Medical Services Advisory Committee (MSAC) is responsible for the assessment of medical imaging tests proposed for public funding. A number of factors related to the clinical or cost effectiveness of an imaging service may impact on the funding decision.

OBJECTIVE

To determine what evidentiary and economic factors impact most on MSAC recommendations for the funding of imaging tests.

METHODS

Information was extracted on health technology assessments (HTAs) of medical imaging tests published on the MSAC website, with a funding decision between 2006 to July 2021. Imaging tests with diagnostic, staging or screening indications were eligible. Data were extracted in test-indication pairs and included data on evidence quality, quantity, consistency of findings, cost-effectiveness and financial impact. Multivariate logistic regression analysis was performed with adjustments for clustered data.

RESULTS

Overall, 42 imaging test applications to MSAC were included, representing 91 clinical indications. Most were diagnostic tests. The most common evidentiary concerns reported by MSAC were limited evidence (36%), low quality evidence (26%), and applicability of the data (22%). The reference standard for diagnostic accuracy was imperfect or not appropriate in 25% of the indications. In regression analyses, uncertainty about cost-effectiveness of an imaging service predicted most negative funding decisions.

CONCLUSIONS

The single biggest contributor to a negative funding decision by MSAC was uncertainty about the cost-effectiveness of the imaging service. This was likely driven by uncertainty regarding the impact on patient health. HTAs that are able to demonstrate the clinical utility of a new imaging service are more likely to publicly funded.