Use of X-rays in family practice A multicentre study

Practising physicians, faced with pressure to control healthcare costs, are increasingly being asked to incorporate considerationsof cost into their decisions regarding the care they offer theirpatients. Accordingly, it is of importance to know how the moneyis spent. The use and cost of X-rays in family practice, andwhat factors influence it, is not well known. The aim of thisstudy is to analyse the use and the cost of X-ray requests infamily practice. A prospective practice study from 16 Icelandiccommunity health centres (HC) with computerised contact dataand their target populations, 12 rural and four urban, was carriedout. The X-ray requests, numbers, types and cost were analysed.Patient and practice characteristics were used to assess variationin X-ray practices. A total of 5173 X-ray requests were recorded,which comprised 3.2% of all office visits. The mean number ofX-ray requests was 24.7 and 14.7/1000 contacts in rural andurban HCs respectively, and 123.1/1000 inhabitants in ruralHCs. The X-ray request rate per individual increased with age,but per contact it was highest among young males. Extremityand chest X-rays were the most common requests. For every 1000individuals added to a practice population, the likelihood ofhaving an X-ray requested decreased by 18%. The use of X-rayexaminations in family practices represents approximately 17%of all ambulatory X-ray use in Iceland. The calculated costof X-rays requested in this study was $6157/1000 inhabitantsper year as of October 1993. The rate of X-rays requested differsgreatly among doctors, which indicates potential for savingsin the health care system, through radiology guidelines. Thisstudy indicates that the rate and the cost of X-rays are lowin general practice in Iceland. X-ray facilities should be adequateand accessible to each practice. The results of this study areuseful in quality control, organisation and in the analysisof cost in the health care system. Training of family doctorsneeds to take this information into account.