Institute of Public Health, National Yang-Ming University, No. 155, Sec. 2,Li-Nong Street, Taipei, Taiwan.
BMC Health Serv Res. 2013 Jul 23;13:284. doi: 10.1186/1472-6963-13-284.
Advances in radiology technology have contributed to a substantial increase in utilization of radiology services. Physicians, who are well educated in medical matters, would be expected to be knowledgeable about prudent or injudicious use of radiological services. The aim of this study was to evaluate differences in the utilization of radiology modalities among physician and non-physician patients.
This nationwide population-based cohort study was carried out using data obtained from the Taiwan National Insurance Database from 1997 to 2008. Physicians and comparison controls selected by propensity score matching were enrolled in the current study. The claims data of ambulatory care and inpatient discharge records were used to measure the utilization of various radiology modalities. Utilization rates of each modality were compared between physicians and non-physicians, and odds ratios of the utilization of each radiology modality were measured. Multiple logistic regression analysis was used to examine the predictors of X-ray, MRI, and interventional procedures utilization during the study period.
The utilization of most radiologic services increased among physicians and the comparison group during the observation period. Compared to non-physicians, physicians had significantly higher utilization rates of computed tomography and magnetic resonance imaging (MRI) but lower utilization rates of X-rays, sonography, and interventional procedures. After adjusting for age, gender, major diseases, urbanicity, and residential regions, logistic regression analysis showed that, compared to non-physicians, the physicians used significantly more MRI (odds ratio [OR]: 2.19, 95% confidence interval [CI]: 1.68-2.84, P < 0.001) and significantly less X-rays and interventional procedures (OR: 0.85, 95% CI: 0.72-0.99, P = 0.04 for X-rays and OR: 0.67, 95% CI: 0.54-0.83, P < 0.001 for interventional procedures). Being a physician was a significant predictor of greater usage of MRI and of less usage of X-ray and interventional procedures.
This study revealed different utilization patterns of X-rays, MRI, and interventional procedures between physician and non-physician patients, even after controlling for such factors as socioeconomic status and major diseases.
放射学技术的进步导致放射学服务的利用率大幅增加。受过医学专业教育的医生应该了解放射学服务的合理和不合理使用。本研究旨在评估医生和非医生患者之间放射学模式利用的差异。
本研究采用了 1997 年至 2008 年从台湾全民保险数据库中获取的数据进行了一项全国性基于人群的队列研究。通过倾向评分匹配选择医生和对照组患者纳入本研究。利用门诊和住院记录的理赔数据来衡量各种放射学模式的利用情况。比较了医生和非医生之间每种模式的利用率，并测量了每种放射学模式的利用率的比值比。采用多因素逻辑回归分析来检验研究期间 X 光、MRI 和介入程序利用的预测因素。
在观察期间，大多数放射学服务的利用率在医生和对照组中均增加。与非医生相比，医生的计算机断层扫描和磁共振成像（MRI）利用率明显更高，但 X 光、超声和介入程序的利用率较低。在调整年龄、性别、主要疾病、城市和居住地区后，逻辑回归分析表明，与非医生相比，医生使用 MRI 的频率显著更高（比值比[OR]：2.19，95%置信区间[CI]：1.68-2.84，P<0.001），而 X 光和介入程序的利用率显著更低（OR：0.85，95%CI：0.72-0.99，P=0.04 用于 X 光，OR：0.67，95%CI：0.54-0.83，P<0.001 用于介入程序）。作为医生是使用 MRI 更多和使用 X 光和介入程序更少的显著预测因素。
即使在控制社会经济地位和主要疾病等因素后，本研究仍揭示了医生和非医生患者之间 X 光、MRI 和介入程序的不同利用模式。
