TY - JOUR
T1 - Associations between general practice characteristics and chest X-ray rate
T2 - an observational study
AU - Bradley, Stephen H.
AU - Barclay, Matthew
AU - Cornwell, Benjamin
AU - Abel, Gary A.
AU - Callister, Matthew Ej
AU - Gomez-Cano, Mayam
AU - Round, Thomas
AU - Shinkins, Bethany
AU - Neal, Richard D.
N1 - Funding Information:
This research arises from the CanTest Collaborative, which is funded by Cancer Research UK (reference: C8640/A23385), of which Stephen H Bradley is a clinical research fellow, Bethany Shinkins and Gary A Abel are senior faculty members, and Richard D Neal is associate director. Thomas Round is funded by a National Institute for Health and Research (NIHR) Doctoral Research Fellowship (reference: DRF-2016-09-054). Gary A Abel was supported by the NIHR Applied Research Collaboration South West Peninsula.
Publisher Copyright:
© The Authors
PY - 2022/1/1
Y1 - 2022/1/1
N2 - BACKGROUND: Chest X-ray (CXR) is the first-line test for lung cancer in many settings. Previous research has suggested that higher utilisation of CXR is associated with improved outcomes. AIM: To explore the associations between characteristics of general practices and frequency of investigation with CXR. DESIGN AND SETTING: Retrospective observational study of English general practices. METHOD: A database was constructed of English general practices containing number of CXRs requested and data on practices for 2018, including patient and staff demographics, smoking prevalence, deprivation, and patient satisfaction indicators. Mixed-effects Poisson modelling was used to account for variation because of chance and to estimate the amount of remaining variation that could be attributed to practice and population characteristics. RESULTS: There was substantial variation in GP CXR rates (median 34 per 1000 patients, interquartile range 26-43). Only 18% of between-practice variance in CXR rate was accounted for by recorded characteristics. Higher practice scores for continuity and communication skills, and higher proportions of smokers, Asian and mixed ethnic groups, and patients aged >65 years were associated with increased CXR rates. Higher patient satisfaction scores for access and greater proportions of male patients and patients of Black ethnicity were associated with lower CXR rates. CONCLUSION: Substantial variation was found in CXR rates beyond that expected by chance, which could not be accounted for by practices' recorded characteristics. As other research has indicated that increasing CXR rates can lead to earlier detection, supporting practices that currently investigate infrequently could be an effective strategy to improve lung cancer outcomes.
AB - BACKGROUND: Chest X-ray (CXR) is the first-line test for lung cancer in many settings. Previous research has suggested that higher utilisation of CXR is associated with improved outcomes. AIM: To explore the associations between characteristics of general practices and frequency of investigation with CXR. DESIGN AND SETTING: Retrospective observational study of English general practices. METHOD: A database was constructed of English general practices containing number of CXRs requested and data on practices for 2018, including patient and staff demographics, smoking prevalence, deprivation, and patient satisfaction indicators. Mixed-effects Poisson modelling was used to account for variation because of chance and to estimate the amount of remaining variation that could be attributed to practice and population characteristics. RESULTS: There was substantial variation in GP CXR rates (median 34 per 1000 patients, interquartile range 26-43). Only 18% of between-practice variance in CXR rate was accounted for by recorded characteristics. Higher practice scores for continuity and communication skills, and higher proportions of smokers, Asian and mixed ethnic groups, and patients aged >65 years were associated with increased CXR rates. Higher patient satisfaction scores for access and greater proportions of male patients and patients of Black ethnicity were associated with lower CXR rates. CONCLUSION: Substantial variation was found in CXR rates beyond that expected by chance, which could not be accounted for by practices' recorded characteristics. As other research has indicated that increasing CXR rates can lead to earlier detection, supporting practices that currently investigate infrequently could be an effective strategy to improve lung cancer outcomes.
KW - cancer diagnosis
KW - chest X-ray
KW - general practice
KW - lung cancer
KW - outcome assessment, health care
KW - referral and consultation
UR - http://www.scopus.com/inward/record.url?scp=85123226571&partnerID=8YFLogxK
U2 - 10.3399/BJGP.2021.0232
DO - 10.3399/BJGP.2021.0232
M3 - Article
C2 - 34903518
AN - SCOPUS:85123226571
SN - 0960-1643
VL - 72
SP - e34-e42
JO - The British journal of general practice : the journal of the Royal College of General Practitioners
JF - The British journal of general practice : the journal of the Royal College of General Practitioners
IS - 714
ER -
