The inappropriateness of brain MRI prescriptions: a study from Iran

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

Inappropriate prescriptions can lead to adverse consequences for patients. It also imposes excessive cost on the patients, payers and health systems. The current study aimed at estimating the rate of inappropriate brain Magnetic Resonance Imaging (MRI) prescriptions and their financial burden in Iran.

Methods

Using systematic stratified sampling method, this cross-sectional study recruited 385 participants from three public teaching hospitals in Shiraz, Iran. Demographic information, questions related to brain MRI prescription and its indications checklist were collected using study-specific data collection tools. The completed indications checklist was compared to the appropriateness status table of indications and scenarios to detect the percent of the appropriateness of prescriptions.

Results

About 21 percentage of total brain MRI prescriptions are inappropriate. Previous treatment, number of referrals to physician, having other diagnostic tests and the applicant of MRI (P < 0.01) had significant relationships with prescription appropriateness. The estimated financial burden of inappropriate brain MRIs in Shiraz teaching hospitals was 99,988 US dollar in 2017.

Conclusions

More than one-fifth of brains MRIs were inappropriate (i.e. prescriptions without medical indications). It caused 99,988 United States Dollar (USD) financial burden which is 17 times that of Iran's Gross Domestic Product (GDP) per capita. To better allocate resources for the provision of MRI services to health system, rationing policies for controlling moral hazard and reducing provider induced demand can be helpful.

Related collections

Most cited references 25

Record: found
Abstract: found
Article: not found

Imaging brain amyloid in Alzheimer's disease with Pittsburgh Compound-B.

William Klunk, Henry Engler, Agneta Nordberg … (2004)

This report describes the first human study of a novel amyloid-imaging positron emission tomography (PET) tracer, termed Pittsburgh Compound-B (PIB), in 16 patients with diagnosed mild AD and 9 controls. Compared with controls, AD patients typically showed marked retention of PIB in areas of association cortex known to contain large amounts of amyloid deposits in AD. In the AD patient group, PIB retention was increased most prominently in frontal cortex (1.94-fold, p = 0.0001). Large increases also were observed in parietal (1.71-fold, p = 0.0002), temporal (1.52-fold, p = 0.002), and occipital (1.54-fold, p = 0.002) cortex and the striatum (1.76-fold, p = 0.0001). PIB retention was equivalent in AD patients and controls in areas known to be relatively unaffected by amyloid deposition (such as subcortical white matter, pons, and cerebellum). Studies in three young (21 years) and six older healthy controls (69.5 +/- 11 years) showed low PIB retention in cortical areas and no significant group differences between young and older controls. In cortical areas, PIB retention correlated inversely with cerebral glucose metabolism determined with 18F-fluorodeoxyglucose. This relationship was most robust in the parietal cortex (r = -0.72; p = 0.0001). The results suggest that PET imaging with the novel tracer, PIB, can provide quantitative information on amyloid deposits in living subjects.

0 comments Cited 368 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

Trends in age‐related disease burden and healthcare utilization

Vincenzo Atella, Andrea Piano Mortari, Joanna Kopinska … (2018)

Abstract Aging is a strong risk factor for many chronic diseases. However, the impact of an aging population on the prevalence of chronic diseases and related healthcare costs are not known. We used a prevalence‐based approach that combines accurate clinical and drug prescription data from Health Search CSD‐LPD. This is a longitudinal observational data set containing computer‐based patient records collected by Italian general practitioners (GP) and up‐to‐date healthcare expenditures data from the SiSSI Project. The analysis is based on data collected by 900 GP on an unbalanced sample of more than 1 million patients aged 35+, observed in different time periods between 2005 and 2014. In 2014, 86% of the Italian adults older than 65 had at least one chronic condition, and 56.7% had two or more. Prevalence of multiple chronic diseases and healthcare utilization increased among older and younger adults between 2004 and 2014. Indeed, in the last 10 years, average number of prescriptions increased by approximately 26%, while laboratory and diagnostic tests by 27%. The average number of DDD prescribed increased with age in all the observed years (from 114 in 2005 to 119.9 in 2014 for the 35–50 age group and from 774.9 to 1,178.1 for the 81+ patients). The alarming rising trends in the prevalence of chronic disease and associated healthcare costs in Italy, as well as in many other developed countries, call for an urgent implementation of interventions that prevent or slow the accumulation of metabolic and molecular damage associated with multiple chronic disease.

0 comments Cited 127 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Addressing overutilization in medical imaging.

James Borgstede, W Hendee, Stéphanie J E Becker … (2010)

The growth in medical imaging over the past 2 decades has yielded unarguable benefits to patients in terms of longer lives of higher quality. This growth reflects new technologies and applications, including high-tech services such as multisection computed tomography (CT), magnetic resonance (MR) imaging, and positron emission tomography (PET). Some part of the growth, however, can be attributed to the overutilization of imaging services. This report examines the causes of the overutilization of imaging and identifies ways of addressing the causes so that overutilization can be reduced. In August 2009, the American Board of Radiology Foundation hosted a 2-day summit to discuss the causes and effects of the overutilization of imaging. More than 60 organizations were represented at the meeting, including health care accreditation and certification entities, foundations, government agencies, hospital and health systems, insurers, medical societies, health care quality consortia, and standards and regulatory agencies. Key forces influencing overutilization were identified. These include the payment mechanisms and financial incentives in the U.S. health care system; the practice behavior of referring physicians; self-referral, including referral for additional radiologic examinations; defensive medicine; missed educational opportunities when inappropriate procedures are requested; patient expectations; and duplicate imaging studies. Summit participants suggested several areas for improvement to reduce overutilization, including a national collaborative effort to develop evidence-based appropriateness criteria for imaging; greater use of practice guidelines in requesting and conducting imaging studies; decision support at point of care; education of referring physicians, patients, and the public; accreditation of imaging facilities; management of self-referral and defensive medicine; and payment reform.

0 comments Cited 113 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Mohsen Bayati:

ORCID: http://orcid.org/0000-0002-9118-5447

bayatim66@gmail.com

Journal

Journal ID (nlm-ta): Cost Eff Resour Alloc

Journal ID (iso-abbrev): Cost Eff Resour Alloc

Title: Cost Effectiveness and Resource Allocation : C/E

Publisher: BioMed Central (London )

ISSN (Electronic): 1478-7547

Publication date (Electronic): 5 March 2021

Publication date PMC-release: 5 March 2021

Publication date Collection: 2021

Volume: 19

Electronic Location Identifier: 14

Affiliations

[1 ]GRID grid.412571.4, ISNI 0000 0000 8819 4698, Health Human Resources Research Center, School of Management and Information Sciences, , Shiraz University of Medical Sciences, ; Almas Building, Alley 29, Qasrodasht Ave, Shiraz, Iran

[2 ]GRID grid.411832.d, Health Policy and Management Department, , Bushehr University of Medical Sciences, ; Bushehr, Iran

Author information

Mohsen Bayati http://orcid.org/0000-0002-9118-5447

Article

Publisher ID: 268

DOI: 10.1186/s12962-021-00268-6

PMC ID: 7934493

PubMed ID: 33663526

SO-VID: a1dc3431-7f5e-456c-b85c-35ca3fd8fbb8

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 14 January 2020

Date accepted : 26 February 2021

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100004320, Shiraz University of Medical Sciences;

Award ID: 13862

Award Recipient : Zahra Kavosi

Custom metadata

ScienceOpen disciplines: Public health

Keywords: magnetic resonance imaging,health expenditures,medical overuse,unnecessary procedures,neurology,prescriptions

Data availability:

ScienceOpen disciplines: Public health

Keywords: magnetic resonance imaging, health expenditures, medical overuse, unnecessary procedures, neurology, prescriptions

The inappropriateness of brain MRI prescriptions: a study from Iran

Read this article at

Abstract

Background

Methods

Results

Conclusions

Related collections

Karger: Neurology and Neuroscience

Most cited references 25

Imaging brain amyloid in Alzheimer's disease with Pittsburgh Compound-B.

Trends in age‐related disease burden and healthcare utilization

Addressing overutilization in medical imaging.

Author and article information

Contributors

Journal

Affiliations

Author information

Article

History

Funding

Categories

Custom metadata

Comments

Comment on this article

Similar content 285

Cited by 2

Most referenced authors 243