Department of Health Sciences Gjøvik, Norwegian University of Science and Technology (NTNU), NTNU Gjøvik, PB 191, 2802, Gjøvik, Norway.
Centre for Medical Ethics, University of Oslo, Blindern, PB 1130, 0318, Oslo, Norway.
BMC Health Serv Res. 2023 Mar 28;23(1):295. doi: 10.1186/s12913-023-09328-4.
One kind of overutilization of diagnostic imaging is low-value imaging, i.e., imaging that does not lead to altered clinical pathways or improved health outcomes. Despite having well-documented extension and consequences, low-value imaging is still widespread. The objective of this study was to identify the drivers for the use of low-value imaging in the Norwegian healthcare services.
We conducted individual, semi-structured interviews among representatives from the health authorities, general practitioners, specialists working in hospitals, radiologists, radiographers, and managers of imaging departments. Data analysis was carried out in line with framework analysis consisting of five steps: Familiarization, indexing, charting, mapping, and interpretation.
The analysis included 27 participants and resulted in two themes. The stakeholders identified drivers in the healthcare system and in the interaction between radiologists, referrers, and patients. The identified drivers were categorized in sub-themes, such as organization, communication, competence, expectations, defensive medicine, roles and responsibilities, and referral quality and time constraints. The drivers interact with each other and may strengthen the effect of other drivers.
Several drivers for low-value imaging in Norway were identified at all levels of the healthcare system. The drivers work simultaneously and synergistically. To free resources for high-value imaging, drivers should be targeted by appropriate measures at several levels to reduce low-value imaging.
诊断影像学的一种过度使用是低价值影像学，即不会改变临床路径或改善健康结果的影像学。尽管低价值影像学有充分记录的扩展和后果，但它仍然广泛存在。本研究的目的是确定挪威医疗保健服务中使用低价值影像学的驱动因素。
我们在卫生当局、全科医生、在医院工作的专家、放射科医生、放射技师和影像部门管理人员中进行了个人、半结构化访谈。数据分析符合框架分析，包括五个步骤：熟悉、索引、图表、映射和解释。
分析包括 27 名参与者，得出了两个主题。利益相关者确定了医疗保健系统中的驱动因素以及放射科医生、转诊医生和患者之间的相互作用。确定的驱动因素分为组织、沟通、能力、期望、防御性医疗、角色和责任以及转诊质量和时间限制等子主题。这些驱动因素相互作用，并可能加强其他驱动因素的影响。
在挪威的医疗保健系统的各个层面都确定了低价值影像学的几个驱动因素。这些驱动因素同时协同工作。为了为高价值影像学腾出资源，应在多个层面上针对这些驱动因素采取适当措施，以减少低价值影像学的使用。
