旨在减少腰痛影像学检查使用的干预措施的有效性：一项系统评价。
Effectiveness of interventions designed to reduce the use of imaging for low-back pain: a systematic review.
作者信息
Jenkins Hazel J, Hancock Mark J, French Simon D, Maher Chris G, Engel Roger M, Magnussen John S
机构信息
Department of Health Professions (Jenkins, Hancock), Macquarie University, Sydney, Australia; School of Rehabilitation Therapy (French), Queen's University, Kingston, Ont.; The George Institute for Global Health (Maher), Sydney Medical School, The University of Sydney, Sydney, Australia; Department of Chiropractic (Engel), Macquarie University, Sydney, Australia; Australian School of Advanced Medicine (Magnussen), Macquarie University, Sydney, Australia
Department of Health Professions (Jenkins, Hancock), Macquarie University, Sydney, Australia; School of Rehabilitation Therapy (French), Queen's University, Kingston, Ont.; The George Institute for Global Health (Maher), Sydney Medical School, The University of Sydney, Sydney, Australia; Department of Chiropractic (Engel), Macquarie University, Sydney, Australia; Australian School of Advanced Medicine (Magnussen), Macquarie University, Sydney, Australia.
出版信息
CMAJ. 2015 Apr 7;187(6):401-408. doi: 10.1503/cmaj.141183. Epub 2015 Mar 2.
BACKGROUND
Rates of imaging for low-back pain are high and are associated with increased health care costs and radiation exposure as well as potentially poorer patient outcomes. We conducted a systematic review to investigate the effectiveness of interventions aimed at reducing the use of imaging for low-back pain.
METHODS
We searched MEDLINE, Embase, CINAHL and the Cochrane Central Register of Controlled Trials from the earliest records to June 23, 2014. We included randomized controlled trials, controlled clinical trials and interrupted time series studies that assessed interventions designed to reduce the use of imaging in any clinical setting, including primary, emergency and specialist care. Two independent reviewers extracted data and assessed risk of bias. We used raw data on imaging rates to calculate summary statistics. Study heterogeneity prevented meta-analysis.
RESULTS
A total of 8500 records were identified through the literature search. Of the 54 potentially eligible studies reviewed in full, 7 were included in our review. Clinical decision support involving a modified referral form in a hospital setting reduced imaging by 36.8% (95% confidence interval [CI] 33.2% to 40.5%). Targeted reminders to primary care physicians of appropriate indications for imaging reduced referrals for imaging by 22.5% (95% CI 8.4% to 36.8%). Interventions that used practitioner audits and feedback, practitioner education or guideline dissemination did not significantly reduce imaging rates. Lack of power within some of the included studies resulted in lack of statistical significance despite potentially clinically important effects.
INTERPRETATION
Clinical decision support in a hospital setting and targeted reminders to primary care doctors were effective interventions in reducing the use of imaging for low-back pain. These are potentially low-cost interventions that would substantially decrease medical expenditures associated with the management of low-back pain.
背景
腰痛的影像学检查率很高，这与医疗保健成本增加、辐射暴露以及患者预后可能较差有关。我们进行了一项系统评价，以调查旨在减少腰痛影像学检查使用的干预措施的有效性。
方法
我们检索了MEDLINE、Embase、CINAHL和Cochrane对照试验中央注册库，检索时间从最早记录到2014年6月23日。我们纳入了随机对照试验、对照临床试验和中断时间序列研究，这些研究评估了旨在减少在任何临床环境（包括初级、急诊和专科护理）中影像学检查使用的干预措施。两名独立 reviewers提取数据并评估偏倚风险。我们使用影像学检查率的原始数据来计算汇总统计量。研究异质性妨碍了荟萃分析。
结果
通过文献检索共识别出8500条记录。在全面审查的54项潜在符合条件的研究中，有7项纳入了我们的评价。在医院环境中采用改良转诊表的临床决策支持使影像学检查减少了36.8%（95%置信区间[CI]33.2%至40.5%）。针对初级保健医生进行适当影像学检查指征的针对性提醒使影像学检查转诊减少了22.5%（95%CI 8.4%至36.8%）。使用从业者审核与反馈、从业者教育或指南传播的干预措施并未显著降低影像学检查率。尽管某些纳入研究可能具有重要临床效果，但由于样本量不足导致缺乏统计学意义。
解读
医院环境中的临床决策支持以及对初级保健医生的针对性提醒是减少腰痛影像学检查使用的有效干预措施。这些可能是低成本干预措施，将大幅降低与腰痛管理相关的医疗支出。
Zotero 插件