TACQual study: assessment and improvement of the requests of lumbar spine CT scans

Abstract

Aim: To characterize the main reasons for requesting lumbar spine computed tomography (CT) scans at primary care units wi-thin a Local Health Unit (ULS), and to intervene in order to improve the quality of such requests. Type of study: Quasi-experimental, pre- post assessment. Local: Six Functional Units (UF) of ULS. Population: Forty-nine family physicians. Methods: All the lumbar spine CT scans performed between October 1, 2014 and March 31, 2015 were reviewed regarding the number of requests and clinical information, which allowed their classification as “acceptable” or “not acceptable”, accordingly to the current scientific evidence, and to the protocol between ACeS and orthopedics department of ULS. In September 2015, a clinical education session was carried out at each of the participating units, where the results were presented and the protocol disseminated. A 20% increase in the number of ‘acceptable’ request was agreed. A second assessment was performed evaluating the CT scans requested by the same family physicians between October 1, 2015 and March 31, 2016. Efficacy of the intervention was defined as a decrease in the absolute number of CT scan requests, and the increase of the proportion of ‘acceptable’ requests. Results: After the intervention, a 39.5% reduction in the overall number of CT scans requested was observed (387 vs 234), and a statistically significant increase in the number of requests classified as ‘acceptable’ (7.7% vs 15.2%, p=0.0091). However, despite this increase, the proportion of requests classified as ‘not acceptable’ remained high (84.8%). Conclusion: The scarcity/unintelligibility of clinical information may have led to the underestimation of the number of ‘acceptable’ requests. In spite of the favorable outcomes, a new intervention will be necessary for a more significant and sustained reduction of the proportion of ‘not unacceptable’ requests.