Robling M, Kinnersley P, Houston H, Hourihan M, Cohen D, Hale J
Department of General Practice, University of Wales College of Medicine, Llanedeyrn Health Centre, Cardiff, UK.
Fam Pract. 1998 Jun;15(3):236-43. doi: 10.1093/fampra/15.3.236.
Direct access to Magnetic Resonance Imaging (MRI) is becoming available to GPs in the UK, offering major benefits for the improved diagnosis and management of certain clinical conditions. Variations in usage of this service may be large, and effective locally produced guidelines are not currently available. The Department of General Practice is conducting a research programme to develop and evaluate methods to optimize MRI use by GPs.
We aimed to describe the current use of MRI by GPs in South Glamorgan; to summarize their reasons for requesting MRI; and to produce criteria to assess the appropriateness of magnetic resonance (MR) scan requests.
Using the critical incident technique, 25 GPs were interviewed about recent scans requested for patients with knee and lumbar spine complaints. A local panel of primary and secondary care doctors was convened to develop criteria for assessing MR scan requests.
Sixty-two scan requests were discussed. Doctors' reasons for requesting MR scans were identified and classified. Reasons for requests included personal, contextual and biomedical variables. Fifteen patients (24%) were managed in primary care following MRI when otherwise they would have been referred. When referrals were made, GPs felt able to reinforce the request and occasionally to direct the patient somewhere more appropriate. The panel reviewed the interview data to produce objective criteria to assess scan requests. The criteria reflect the relative importance of non-biomedical variables in the decision to request MRI.
The study identified those reasons which are important to GPs when requesting MR scans and the impact of this new technology upon patient management. Interview data have been used to inform locally developed consensus criteria, which will be made available as practice guidelines as the research programme progresses.
在英国，全科医生（GP）可直接使用磁共振成像（MRI），这为改善某些临床病症的诊断和管理带来了重大益处。这项服务的使用差异可能很大，目前尚无有效的本地制定指南。全科医学部正在开展一项研究计划，以开发和评估优化全科医生使用MRI的方法。
我们旨在描述南格拉摩根郡全科医生目前对MRI的使用情况；总结他们要求进行MRI检查的原因；并制定评估磁共振（MR）扫描申请合理性的标准。
采用关键事件技术，就近期为膝关节和腰椎疾病患者申请的扫描，对25名全科医生进行了访谈。召集了一个由初级和二级医疗保健医生组成的地方小组，以制定评估MR扫描申请的标准。
共讨论了62份扫描申请。确定并分类了医生要求进行MR扫描的原因。申请原因包括个人、背景和生物医学变量。15名患者（24%）在进行MRI检查后在初级医疗保健机构接受治疗，否则他们会被转诊。当进行转诊时，全科医生认为能够强化申请，偶尔还能将患者转诊到更合适的地方。该小组审查了访谈数据，以制定评估扫描申请的客观标准。这些标准反映了非生物医学变量在决定是否申请MRI时的相对重要性。
该研究确定了全科医生在要求进行MR扫描时重要的那些原因，以及这项新技术对患者管理的影响。访谈数据已用于为本地制定的共识标准提供信息，随着研究计划的推进，这些标准将作为实践指南提供。
