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More scans ordered for back pain, despite guidelines

by Nancy Ryerson, Staff Writer | August 12, 2013
More patients than ever before are getting advanced imaging scans for back pain, despite national guidelines that support alternate treatment, a new study found.

The number of CT and MRI images increased from 7.2 percent to 11.3 percent of back pain visits between 1999-2000 and 2009-2010, according to a study published in the July issue of JAMA. The number of high-risk back pain patients who would require advanced imaging has not increased during that time, however.

Advanced imaging scans have increased while the patient population has stayed the same in part because the number of MRI and CT scanners in use has grown, study author Dr. John Mafi, told DOTmed News.
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It may also be an unintended consequence of one of health care's key goals: patient engagement.

"Patients are doing their research, and they see other patients getting MRIs," said Mafi. "I think what's happening is they're starting to have more expectations of getting an MRI or CT. They see it as a sign that their doctor was really listening to them."

Doctors are also being judged increasingly by patient satisfaction, and patients are writing reviews of their visits online. Just like customers who review restaurants, patients are happiest when they get their special requests.

Mafi suggested that in order for inappropriate imaging rates to drop, a financial incentive will need to be in place to support patient counseling over inappropriate imaging.

"Doctors need to be given time to talk to patients, and actually get paid for it," said Mafi.

He said the doctor should be rewarded for suggesting physical therapy and basic painkillers like Ibuprofen, as guidelines direct.

But the guidelines themselves may be part of the problem.

In a commentary that accompanied the study, Dr. Donald Casey Jr. notes that a search for "low back pain" into the Agency for Healthcare Research and Quality Guideline Clearinghouse yielded 183 specific citations.

"Keeping track is a challenge," Casey said to DOTmed News. "We shouldn't just publish guidelines, but actually help physicians in the practices and provide better guidance about how to implement the guidelines."

Physicians should be able to see information on their own patterns of care and where they can improve, Casey said.

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