AN EXPLORATION OF GPS USE OF MRI - A CRITICAL INCIDENT STUDY

Background. Direct access to Magnetic Resonance Imaging (MRI) is becom ing available to GPs in the UK, offering major benefits for the improv ed diagnosis and management of certain clinical conditions. Variations in usage of this service may be large, and effective locally produced guidelines are not currently available. The Department of General Pra ctice is conducting a research programme to develop and evaluate metho ds to optimize MRI use by GPs. Objectives. We aimed to describe the cu rrent use of MRI by GPs in South Glamorgan; to summarize their reasons for requesting MRI; and to produce criteria to assess the appropriate ness of magnetic resonance (MR) scan requests. Methods. Using the crit ical incident technique, 25 GPs were interviewed about recent scans re quested for patients with knee and lumbar spine complaints. A local pa nel of primary and secondary care doctors was convened to develop crit eria for assessing MR scan requests. Results. Sixty-two scan requests were discussed. Doctors' reasons for requesting MR scans were identifi ed and classified. Reasons for requests included personal, contextual and biomedical variables. Fifteen patients (24%) were managed in prima ry care following MRI when otherwise they would have been referred. Wh en referrals were made, GPs felt able to reinforce the request and occ asionally to direct the patient somewhere more appropriate. The panel reviewed the interview data to produce objective criteria to assess sc an requests. The criteria reflect the relative importance of non-biome dical variables in the decision to request MRI. Conclusion. The study identified those reasons which are important to GPs when requesting MR scans and the impact of this new technology upon patient management. Interview data have been used to inform locally developed consensus cr iteria, which will be made available as practice guidelines as the res earch programme progresses.