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Doctors say access to MRI and CT scans is better, but care may not have improved


Substantial gains have been made in the number of Magnetic Resonance Imaging (MRI) and Computerized Tomography (CT) scans performed each year since the provincial government’s Wait Time Strategy began in 2004. But a study out of the Institute for Clinical Evaluative Sciences (ICES) has found Ontario doctors are not sure how much care has improved.

“We interviewed 19 Ontario doctors from diverse settings across Ontario to get their views on current patterns of CT and MRI use in the province. From the interviews emerged a picture of a fragmented, poorly coordinated healthcare system, with different groups of physicians blaming each other for inappropriate CT and MRI use,” says principal investigator Dr. John You. “Although we heard that access to MRI and CT has improved, we did not hear that care was better.”

The study found:

  • Doctors interviewed said access to CT and MRI is better, but none of the doctors said care has improved as a result
  • Specialists and radiologists identified family physicians as a source of inappropriate ordering
  • Spine surgeons were frustrated by the number of patients they see who are unlikely to benefit from surgery, but they are asked to see because of results on MRI scans they believe were not essential
  • Family physicians, however, were frustrated at the fact that most spine surgeons will not see new referrals unless the patient has first had an MRI
  • The physicians also described marked variations in ordering practices that are often driven by a number of “non-medical” factors, including defensive ordering because of the fear of being sued and patient demand

“Our findings suggest that increases in CT and MRI capacity may not be leading to better care for patients. To get the most return on our investment in CT and MRI services, we need to improve structures and processes within the healthcare system, foster more effective communication between physician groups, and more fully understand the non-medical reasons why physicians and patients order CT and MRI scans,” says Dr. You, ICES scientist and assistant professor of Medicine and Clinical Epidemiology & Biostatistics at McMaster University.

The study “Attitudes of family physicians, specialists and radiologists about the use of computed tomography and magnetic resonance imaging in Ontario” is in the August 14, 2009 issue of Healthcare Policy.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.



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