Evidence for Policy Making: Clinical Appropriateness Study of Lumbar Spine MRI Prescriptions Using RAND Appropriateness Method

摘要

Background: MRI is a new and expensive diagnostic technology, which has been used increasinglyudall over the world. Low back pain is a worldwide prevalent disorder and MRI technique is one ofudthe several ways to diagnose it. This paper aims to identify the appropriateness of lumbar spineudMRI prescriptions in Shiraz teaching hospitals using standardized RAND Appropriateness Methodud(RAM) criteria in 2012.udMethods: This study consisted of two phases. The first phase involved a qualitative enquiry andudthe second phase had a quantitative cross-sectional nature. In the first phase RAM was usedudfor developing lumbar spine MRI indications and scenarios. In the second phase, the finalizedudscenarios were compared with the history and physical examination of 300 patients with low backudpain. The rate of appropriateness of lumbar spine MRI prescription was then calculated.udResults: Of 300 cases of lumbar spine MRI prescriptions, approximately 167 (56%) wereudconsidered inappropriate, 72 (24%) were uncertain, and 61 (20%) were deemed to be appropriate.udThe economic burden of inappropriate prescriptions was calculated at 88,009,000 Rials. Inudaddition, the types of expertise and physical examination were considered as related factors toudappropriateness of prescriptions.udConclusion: In conclusion, a large proportion of lumbar spine MRI prescriptions, which result inudfinancial burden on the insurance companies and the patients alike is unnecessary. This studyudsuggests that policy makers consider this evidence while decision-making. Our findings highlightudthe imperative role of Health Technology Assessment (HTA) and Clinical Practice Guidelines (CPGs).udAs a result, developing local clinical guidelines may create the commitment needed in physiciansudin prescribing appropriate prescriptions within the health sector. The study further recommendsudthat appropriate scenarios should be considered as a criterion for payment and reimbursement.