General Practitioner Access to Diagnostic Imaging: A Scoping Review of Associated Challenges

Conference:

SAPC ASM 2024 - Bristol

Talk Code:

10F.5

Presenter:

Geoff McCombe

Twitter:

@geoffmccombe

Co-authors:

Aisling Mac Manus1, Geoff McCombe1, John Broughan1, Claire Collins2, Ronan Fawsitt3,4, Mike O’Callaghan5, Diarmuid Quinlan2, Fintan Stanley2, Walter Cullen1

Author institutions:

1School of Medicine, University College Dublin, Dublin, Ireland 2 Irish College of General Practitioners, Dublin, Ireland. 3 General Practice, Castle Gardens Medical Centre, Kilkenny, Ireland. 4 Primary Care Advisor, Ireland East Hospital Group, Dublin, Ireland. 5 School of Medicine, University of Limerick, Limerick, Ireland.

Problem

Appropriate and efficient referrals for diagnostic imaging in general practice can have a significant effect on patient outcomes. Early diagnosis can result in improved prognosis. Therefore efforts have been made in recent years to improve General Practitioner (GP) access to diagnostic imaging. This scoping review aims to highlight the challenges faced by GPs following the introduction of enhanced diagnostic imaging referral pathways and how these challenges might be addressed.

Approach

A comprehensive search was conducted of ‘PubMed’, ‘Cochrane Library’, and ‘Google Scholar’. A filter was applied for papers between 2013 and 2023. The Arksey and O’Malley six-stage process was utilised to guide this scoping review, along with the PRISMA extension for Scoping Reviews (PRISMA-ScR) checklist.

Findings

Thirty-two papers from a range of countries were included, (Netherlands, UK, Ireland, USA, Switzerland, Denmark, Japan, Poland, India, Hong Kong, Australia, Singapore, Germany). There were three cohort studies, one review article, two practical guides, three randomised control trials, five retrospective reviews, one mixed methods study, two reports, two scoping reviews, one evaluation of a questionnaire, one clinical trial, six systematic reviews, one narrative review, three literature reviews and one pictorial article. Challenges reported included increased workload for GPs, lack of training in use of diagnostic imaging modalities and insufficient anatomical knowledge.

Consequences

The introduction of new diagnostic imaging referral pathways have provided many patients with improved care and outcomes as for the most part they did not have to access hospital facilities and could avoid hospital queues and delays. This has resulted in many patients receiving accelerated diagnoses and improved prognoses as a result. GPs reported that this new referral pathway also provides a greater sense of patient safety. However, with increased patient numbers attending general practices for diagnostic imaging, follow-up appointments and further testing, has resulted in general practitioners reporting feeling overworked.

Submitted by:

Geoff McCombe

Funding acknowledgement:

We are grateful to Ireland East Hospital Group, the UCD School of Medicine, and the UCD College of Health and Agricultural Sciences for supporting this project and to Medisec Ireland for funding Aisling MacManus to conduct the scoping review.