Choosing Wisely Talks | Identifying Barriers and Implementing Approaches to Reducing Unnecessary Diagnostic Imaging
Diagnostic imaging is one of the largest areas of medical overuse. As demand for these services remains high, inappropriate imaging can significantly impact system capacity and increase wait times. For conditions such as low back pain (LBP) and osteoarthritis of the knee, imaging is often a routine part of care but usually will not help patients get better. To address this issue, it is essential to identify and understand the barriers and drivers of change, as well as what interventions will most appropriately address these complex areas of overuse.
On Wednesday, February 5, we will be joined by Dr. Amanda Hall, the Implementation Research Network Lead for Choosing Wisely Newfoundland and Labrador (NL), to hear how physician-reported barriers to using evidence-based recommendations for LBP in clinical practice could be driving inappropriate LBP imaging. We will also be joined by Dr. Greg Garvin, musculoskeletal and interventional radiologist and Associate Professor in the Department of Medical Imaging at Schulich School of Medicine and Dentistry, to hear about the St. Joseph’s Health Care London experience with reducing inappropriate MRI knee studies after implementation of an appropriateness checklist.
By the end of the webinar participants will understand and appreciate that:
- Explain that patients with low back pain, imaging tests (x-ray, CT and MRI) are not indicated for almost all patients.
- Summarize internationally recognized factors that influence physicians decision to order imaging tests even when they are not indicated
- Offer behaviour change theory as a potential method to help address influencing factors and discuss potential implications of future research regarding barriers for inappropriate imaging ordering
- Highlight that MRI of the knee is not indicated in almost all patients with moderate or greater osteoarthritis of the medial or lateral compartments of the knee.
- Explore how the implementation of a knee appropriateness checklist with moderate efforts at enforcement results in at least a short-term reduction in knee MRIs that are inappropriate because of the presence of osteoarthritis.
- Discuss how further study is required to determine if this reduction can be sustained in the long term.
Missed the webinar? Watch it now.
For more tools and resources covered in this webinar:
Protocol-Testing Interventions to Reduce Unnecessary Imaging for LBP:
- Jenkins, H.J., Moloney, N.A., French, S.D. et al. Using behaviour change theory and preliminary testing to develop an implementation intervention to reduce imaging for low back pain. BMC Health Serv Res 18, 734 (2018).
- Jarvik, J. G., Comstock, B. A., James, K. T., Avins, A. L., Bresnahan, B. W., Deyo, R. A., … Heagerty, P. J. (2015). Lumbar Imaging With Reporting Of Epidemiology (LIRE)–Protocol for a pragmatic cluster randomized trial. Contemporary clinical trials, 45(Pt B), 157–163. doi:10.1016/j.cct.2015.10.003
- Machado GC, Richards B, Needs C for the SHaPED trial Investigators, et al Implementation of an evidence-based model of care for low back pain in emergency departments: protocol for the Sydney Health Partners Emergency Department (SHaPED) trial BJM Open 2018;8:e019052. doi: 10.1136/bmjopen-2017-019052
- Physician-Patient Booklet
- GP Information Sheet
SW LHIN Medical Imaging Integrated Care
- SW LHIN Knee Checklist
- SW LHIN Medical Imaging Integrated Care – Overview Presentation
- SW LHIN Medical Imaging Integrated Care – Full Length Training Video
- SW LHIN Medical Imaging Integrated Care – Introduction & Collaboration
- SW LHIN Medical Imaging Integrated Care – Choosing Wisely
- SW LHIN Medical Imaging Integrated Care – Overview Standardized MRI Forms
- SW LHIN Medical Imaging Integrated Care – MRI Requisition Form
- SW LHIN Medical Imaging Integrated Care – MRI Appropriateness Checklist for Spine
- SW LHIN Medical Imaging Integrated Care – MRI Appropriateness Checklist for Knee
- SW LHIN Medical Imaging Integrated Care – Conclusion
The Choosing Wisely Talks Webinar Series is a Group Learning program that has been certified by the College of Family Physicians of Canada for up to 1 Mainpro+ credits and is a self-approved group learning activity (Section 1) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada.
Please note: Credits will only be granted to those who’ve attended the webinar live.