背景:诊断成像的一种过度利用是低值成像,即,不会导致改变临床途径或改善健康结果的成像。尽管有据可查的扩展和后果,低值成像仍然很普遍。这项研究的目的是确定在挪威医疗保健服务中使用低价值成像的驱动因素。
方法:我们进行了个人,卫生当局代表之间的半结构化访谈,全科医生,在医院工作的专家,放射科医生,放射技师,和影像部门的经理。数据分析是按照框架分析进行的,包括五个步骤:熟悉,索引,绘制图表,映射,和解释。
结果:分析包括27名参与者,并得出两个主题。利益相关者确定了医疗保健系统和放射科医师之间互动的驱动因素,推荐人,和病人。识别出的驱动因素按子主题分类,如组织、通信,能力,期望,防御医学,角色和责任,以及转诊质量和时间限制。驾驶员彼此交互并且可以加强其他驾驶员的效果。
结论:在所有级别的医疗保健系统中都确定了挪威低值成像的几个驱动因素。驾驶员同时和协同地工作。要释放用于高价值成像的资源,驾驶员应在多个层面采取适当措施,以减少低值成像。
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.