Strasser R P, Bass M J, Brennan M
J Fam Pract. 1987 Jun;24(6):619-23.
Family physicians around the world are increasing their use of diagnostic x-ray examinations at a time of controversy about radiologic overutilization. To explore the role of accessibility in utilization, a study was undertaken testing the hypothesis that on-site radiology facilities are an important determinant of usage. Using a historical cohort design with chart review, rates in selected groups of patients were compared between two teaching family medicine centers, one with an on-site radiology service and one without. After controlling for confounding variables, patients with chest-related diagnoses were 2.4 times more likely (P less than .05) to have a chest film in the presence of on-site facilities. Rates for the off-site examination, upper gastrointestinal series, in patients with abdominal-related diagnoses were similar (relative risk 1.34, P greater than .5) at both centers. Higher usage brought no short-term clinical benefit. It was also observed that residents overinterpreted one quarter of chest films when compared with radiologists' reports.
在关于放射检查过度使用存在争议的时期，世界各地的家庭医生越来越多地使用诊断性X光检查。为了探讨可及性在使用中的作用，开展了一项研究，检验现场放射设施是使用情况的重要决定因素这一假设。采用历史队列设计并进行图表回顾，比较了两个教学家庭医学中心选定患者组的使用率，一个中心有现场放射服务，另一个没有。在控制了混杂变量后，存在现场设施时，患有胸部相关疾病的患者进行胸部X光检查的可能性高出2.4倍（P小于0.05）。两个中心腹部相关疾病患者进行上消化道造影（非现场检查）的比率相似（相对风险1.34，P大于0.5）。更高的使用率并未带来短期临床益处。还观察到，与放射科医生的报告相比，住院医生对四分之一的胸部X光片解读过度。
