Strategies to optimize management of incidental radiographic findings in the primary care setting: A mixed methods study - 10/02/22
Abstract |
Background |
Incidental adrenal masses (IAMs) are common. Primary care providers (PCPs) are frequently responsible for incidentaloma evaluations. We evaluated whether PCPs view this paradigm effective, barriers faced, and strategies to optimize care delivery.
Methods |
This is a sequential explanatory study, comprised of surveys followed by focus groups of PCPs. Because lung nodules are another type of common incidental finding, we compared PCP views on management of lung nodules to their views on IAMs.
Results |
For IAMs, 22.3% of PCPs “always refer” to specialists, but for lung nodules this was 11.5% (p = 0.026). For lung nodules, the most significant barrier was insufficient time/support to longitudinally follow results (69%), but for IAMs it was uncertainty about which tests to order (68%). Fear of litigation was equal (lung = 22.5%, IAMs = 21.3%). Consistent themes regarding the “ideal” system included specific recommendations in radiology reports; automation of orders for follow-up tests; longitudinal tracking tools; streamlined consultations; and decision guides embedded within the electronic health record.
Conclusions |
Respondents are more comfortable with lung nodules than IAMs. Management of “incidentalomas” is within their scope of practice, but the current system can be optimized.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Compared to lung nodules, PCPs twice as likely to refer adrenal mass to specialists. |
• | PCPs less familiar with adrenal mass evaluation vs lung nodule evaluation. |
• | One-fifth of PCPs report concern with litigation in evaluation of incidentalomas. |
• | Concrete recommendations (i.e. “next steps”) should be included in radiology report. |
• | Decision guides and process automation should be integrated into EHR. |
Keywords : Adrenal gland, Adrenal incidentaloma, Care coordination, Primary care, Endocrine surgery, Mixed methods study
Plan
Vol 223 - N° 2
P. 297-302 - février 2022 Retour au numéro
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