Use of X-rays in family practice A multicentre study

摘要

Practising physicians, faced with pressure to control health care costs, are increasingly being asked to incorporate considerations of cost into their decisions regarding the care they offer their patients. Accordingly, it is of importance to know how the money is spent. The use and cost of X-rays in family practice, and what factors influence it, is not well known. The aim of this study is to analyse the use and the cost of X-ray requests in family practice. A prospective practice study from 16 Icelandic community health centres (HC) with computerised contact data and their target populations, 12 rural and four urban, was carried out. The X-ray requests, numbers, types and cost were analysed. Patient and practice characteristics were used to assess variation in X-ray practices. A total of 5173 X-ray requests were recorded, which comprised 3.2of all office visits. The mean number of X-ray requests was 24.7 and 14.7/1000 contacts in rural and urban HCs respectively, and 123.1/1000 inhabitants in rural HCs. The X-ray request rate per individual increased with age, but per contact it was highest among young males. Extremity and chest X-rays were the most common requests. For every 1000 individuals added to a practice population, the likelihood of having an X-ray requested decreased by 18. The use of X-ray examinations in family practices represents approximately 17of all ambulatory X-ray use in Iceland. The calculated cost of X-rays requested in this study was$6157/1000 inhabitants per year as of October 1993. The rate of X-rays requested differs greatly among doctors, which indicates potential for savings in the health care system, through radiology guidelines. This study indicates that the rate and the cost of X-rays are low in general practice in Iceland. X-ray facilities should be adequate and accessible to each practice. The results of this study are useful in quality control, organisation and in the analysis of cost in the health care system. Training of family doctors needs to take this information into account.