Which patients are most likely to forgo follow-up imaging?

When incidental findings are detected, follow-up imaging is usually recommended. But when it comes to indeterminate abdominal findings, more than 36 percent of patients did not return for follow-up imaging, according to a single-center study published in the American Journal of Roentgenology.

The goal of the study was to identify disparities in imaging follow-up rates after incidental abdominal findings, determining who undergoes follow-up imaging and who does not.

Joshua K. Cho, with the Hospital of the University of Pennsylvania in Philadelphia, and colleagues analyzed data from more than 1,500 patients with indeterminate abdominal findings between July 1, 2013 and March 20, 2014. They found more than 36 percent of those patients didn’t receive follow-up imaging within one year of their exam. Similarly, more than 28 percent of outpatients and 60 percent of emergency department patients did not undergo follow-up imaging.

“Our data suggest that patients may be less likely to complete follow-up imaging when it is recommended in the ED,” Cho et al. wrote. “It is unknown whether this effect is a result of the communication challenges between the radiologist and the ED staff or the patient’s primary care physician (who may be part of a different health care system) or occurs be-cause patients presenting to the ED are using the ED as their source of primary care.”

The group also found nearly 14 percent of those who did not receive follow-up imaging were older than 80, compared to the 9 percent who were younger than 40 years old.

Cho and colleagues wrote that older patients may be less likely to return for imaging because of “more urgent comorbidities,” less need in general if they have advanced illness, lack of access to care or other communication-related problems. Radiologists should be aware of these factors when considering follow-up testing, the authors wrote.

When examining race, the group found more white patients than black were found in the groups who underwent follow-up imaging. However, the exact correlation between race and ethnicity with follow-up imaging remains hard to discern, they wrote.

“Differences in culture, language, opinions about Western medicine, and education and socioeconomic factors have been found to contribute to reasons that patients may not follow health care recommendations,” Cho and colleagues concluded. “Understanding these differences is important for physicians, whose duty it is to provide just and equal care to all patients.”