Patterns of imaging requests by general practitioners for people with musculoskeletal complaints: An analysis from a primary care database.

Abstract

To examine imaging requested by general practitioners (GPs) for patients with low back, neck, shoulder and knee complaints over five years (2014-2018). This analysis from the Australian POpulation Level Analysis Reporting (POLAR) database included patients presenting with a diagnosis of low back, neck, shoulder and/or knee complaints. Eligible imaging requests included low back and neck X-ray, CT and MRI; knee X-ray, CT, MRI and ultrasound; and shoulder X-ray, MRI and ultrasound. We determined number of imaging requests and examined their timing, associated factors and trends over time. Primary analysis included imaging requests from two weeks before diagnosis to one-year post-diagnosis. There were 133,279 patients (57% low back, 25% knee, 20% shoulder and 11% neck complaints). Imaging was most common among those with a shoulder (49%), followed by knee (43%), neck (34%) and low back complaint (26%). Most requests occurred simultaneously with the diagnosis. Imaging modality varied by body region and to a lesser extent by gender, socioeconomic status and PHN. For low back, there was a 1.3% (95% CI 1.0 to 1.6) annual increase in proportion of MRI and concomitant 1.3% (95% CI 0.8 to 1.8) decrease in CT requests. For neck, there was a 3.0% (95% CI 2.1 to 3.9) annual increase in proportion of MRI and concomitant 3.1% (95% CI 2.2 to 4.0) decrease in X-ray requests. GPs commonly request early diagnostic imaging for musculoskeletal complaints at odds with recommended practice. We observed a trend towards more complex imaging for neck and back complaints. This article is protected by copyright. All rights reserved.