Influences on Primary Care Provider Imaging for a Hypothetical Patient with Low Back Pain.

Southern Journal of Medicine 12 (111):758-762 (2018)
Authors
Zackary Berger
Johns Hopkins University
Abstract
OBJECTIVE: How outside factors affect physician decision making remains an open question of vital importance. We sought to investigate the importance of various influences on physician decision making when clinical guidelines differ from patient preference. METHODS: An online survey asking 469 primary care providers (PCPs) across four practice sites whether they would order magnetic resonance imaging for a patient with uncomplicated back pain. Participants were randomized to one of four scenarios: a patient's preference for imaging (control), a patient's preference plus a colleague's opinion against imaging (colleague), a patient's preference plus a professional society's recommendation against imaging (profession), or a patient's preference plus an accountable care organization's quality metric that measures physician use of imaging (ACO). Demographic information and the reasoning behind participants' decisions also were obtained. RESULTS: A total of 168 PCPs completed the survey, yielding a 36% completion rate. A majority chose not to pursue imaging: control 68%, colleague 85%, profession 87%, and ACO 78%. Multivariate logistic regression revealed that participants were more likely not to order advanced imaging only when reminded of a professional society recommendation (P = 0.017). Regression also suggested that practice site exerted an effect on the primary outcome. Evidence-based medicine and clinical judgment were the most cited reasons for the decision. CONCLUSIONS: Our results reinforce the potential to leverage professional societies to advance evidence-based medicine and reduce unnecessary testing. At the same time, practice site appeared to exert influence, suggesting that these recommendations must be part of local institutional culture to be effective.
Keywords decision making, evidence-based medicine, back pain, imaging, physicians, patients  evidence-based medicine   back pain, imaging, physicians, patients   imaging, physicians, patients  physicians
Categories (categorize this paper)
Options
Edit this record
Mark as duplicate
Export citation
Find it on Scholar
Request removal from index
Revision history

Download options

Our Archive


Upload a copy of this paper     Check publisher's policy     Papers currently archived: 37,153
External links

Setup an account with your affiliations in order to access resources via your University's proxy server
Configure custom proxy (use this if your affiliation does not provide a proxy)
Through your library

References found in this work BETA

No references found.

Add more references

Citations of this work BETA

No citations found.

Add more citations

Similar books and articles

The Origins of Medical Evidence: Communication and Experimentation.Joachim Widder - 2004 - Medicine, Health Care and Philosophy 7 (1):99-104.
Ethics of Evidence Based Medicine in the Primary Care Setting.A. Slowther - 2004 - Journal of Medical Ethics 30 (2):151-155.
Neuropsychiatric Diseases Among Chronic Low Back Pain Patients.Tanjimul Islam & Rubab Tarannum Islam - 2016 - International Journal of Sciences and Applied Research 3 (2):83-88.
Dwelling in the Shadow: Physicians' Decision-Making for Terminally Ill Patients.Stephen Vanhooser Mccrary - 1992 - Dissertation, The University of Texas Graduate School of Biomedical Sciences at Galveston
Physician-Patient Relations: No More Models.Greg Clarke, Robert T. Hall & Greg Rosencrance - 2004 - American Journal of Bioethics 4 (2):16 – 19.

Analytics

Added to PP index
2018-12-13

Total downloads
0

Recent downloads (6 months)
0

How can I increase my downloads?

Monthly downloads

Sorry, there are not enough data points to plot this chart.

My notes

Sign in to use this feature