Factors affecting the use of magnetic resonance imaging in a Southern European region: a qualitative study

Abstract

ObjectivesThe use of Magnetic Resonance Imaging (MRI) has increased significantly in recent years. Superior diagnostic capability and extension of criteria for the performance of MRI may explain this increase, but there are also non-clinical factors that influence doctors’ decisions. We aim to describe the views of doctors in the Basque Country (Spain) regarding factors affecting MRI orders. MethodsWe conducted a qualitative study using semi-structured interviews with doctors based on intentional sampling to cover a diverse range of interviewees according to personal and professional characteristics (sex, workplace, post of responsibility). We analyzed transcript content using an inductive approach. ResultsFactors identified by doctors were classified into three themes: 1) superior diagnostic capability of the MRI compared to other imaging modalities has favoured MRI use and inclusion in Clinical Practice Guidelines; 2) patient demands, owing to lower trust and acceptance of doctors’ judgment than to technology-based medicine, leads to patient-doctor relationships that result unnecessary MRI test; 3) structural or contextual aspects of the health system, such as excessive rotation of doctors or a lack of time to carry out a thorough patient examination, which disempower doctors and favour overuse. ConclusionsDoctors identified non-clinical factors that affect MRI use and that lead to unintended consequences both for the healthcare system and for patients. We recommend an organizational approach to give doctors enough resources to overcome non-clinical factors that lead to excessive MRI orders in order to optimize its use.