Nudge letters curb unnecessary imaging

2 minute read

Australian research published in JAMA reports an intervention targeting high-requesting GPs reduced imaging requests by around 10%.

Nudge letters appear to cut imaging requests by around 10% in GPs who frequently requested the diagnostic tools for musculoskeletal problems, according to Australian research published in JAMA.   

Associate Professor Denise O’Connor, of the Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, and colleagues analysed the effects of nudge letters on almost 4000 GPs who were in the top 20% of GP referrers for the target imaging tests.  

Letters from the Chief Medical Officer of Australia compared the recipient’s imaging request rates with that of their peers, with the aim of curbing requests for 11 commonly overused musculoskeletal diagnostic imaging tests. 

Those who received at least one nudge letter made around 2-3 fewer requests per 1000 category 1 consultations over the 18-month study period than their peers who didn’t receive a letter, with 27.7 vs 30.4 requests per 1000 consultations respectively.

This led to an estimated total of 47,000 fewer musculoskeletal imaging test requests, according to Professor O’Connor, who presented the findings at the Australian Rheumatology Association conference in May this year. 

“Compared with control, the feedback intervention resulted in a 10.6% relative reduction in the overall rate of imaging requests over six months, 9.2% over 12 months and 8.0% over 18 months,” Professor O’Connor said. 

While recognising the need to reduce unnecessary imaging, rheumatology professor Graeme Jones suggested it was important not to overlook medicolegal as well as clinical imperatives. 

“In addition, patients get a lot out of seeing what is wrong or not wrong on their scans and there is plenty of evidence out there that individual biofeedback changes behaviour while talking doesn’t,” said Professor Jones. 

“Doing more sensitive scans seems a good thing, provided you follow the first rule of medicine: don’t order a test unless you know how to interpret it,” he added. 

JAMA 2022, online 6 September

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