Pilot program reveals ‘integral’ role radiologists play in advising primary care providers

A new program allowing primary care providers to virtually consult with radiologists positively impacted patient management and avoided many unnecessary imaging tests, highlighting rads’ crucial role on the care team.

Those were the main takeaways from a five-year study gauging the impact of an eConsult platform, undertaken by researchers at the University of Ottawa in Ontario. The team reported the program’s success Tuesday in AJR, pointing to patient care alterations in more than half of cases and avoidance of more than one-quarter of unnecessary imaging exams.

Daniel Walker, with the institution’s radiology department, and colleagues said their findings reinforce the idea that radiologists should be more directly involved in the care continuum. 

“Given rapid advances in medical imaging and the wide variety of imaging modalities and protocols available, our results highlight the integral role that radiologists play in advising PCPs on the most appropriate imaging test to perform,” the authors added. “By providing easy access to expert opinion, we bolster the view that radiologists are useful members of patients' care teams who offer input that alters patient care in over half of cases.”

Compared to conventional specialist consultations, most radiology consults don’t result in direct patient interaction, the authors noted. But prior research has suggested expert opinions play a key role in their care. With this in mind, the electronic platform, known as Champlain BASE, was created for PCPs to securely confer with specialists regarding patient-specific information.

To understand its impact, Walker and colleagues retrospectively analyzed the 302 consults sent to radiologists out of the more than 20,000 performed from September 2012 to January 2017. They keyed in on subspecialties, question type, anatomy, and pathology.

Below are some key takeaways:

  • Abdominal radiology accounted for the most consult cases at 31%, followed by neuroradiology (25%) musculoskeletal (20%), thoracic (19%) and pediatrics (6%).
  • Second opinions were most often about patient work-up (37% of consults), followed by surveillance of imaging findings (31%) and provider education (16%).
  • Cystic lesions accounted for the top-queried conditions (13%), while pain (8%) and bone lesions (7%) followed closely behind.
  • These expert opinions led to patient management changes in 167 cases (55%) and avoided unnecessary imaging in 84 situations (28%).
  • In 227 cases (75%), primary care providers said the eConsult platform offered “excellent” value, according to a small survey sent to participating physicians.

The overall number of imaging consultations was low in this study, but the authors said they anticipate those numbers will continue to grow, and so will the number of avoided radiology exams.

Walker and colleagues also pointed to the large proportion of requests regarding lesions and cysts as a cue for radiologists to provide more detailed reports for PCPs.

“As a result of eConsult, patient care was altered and unnecessary imaging tests were avoided, resulting in more efficient resource use,” the authors concluded. “It may be helpful for radiologists to alter their reporting style to include clear follow-up guidelines for incidental findings, and that PCPs may benefit from continuing medical education on imaging of cystic lesions and use of imaging in the workup of a patient's pain.”

Read more about the program in the American Journal of Roentgenology.