Irish general practitioner (GP) perspectives on impact of direct access radiology on patient care in the community: results from a mixed-methods study.

BACKGROUND: Since winter 2020/21, general practitioners (GPs) in the Republic of Ireland (RoI) have been granted access to diagnostic imaging studies on a new publicly funded pathway, expediting access to services previously obtained via hospital-based doctors. AIMS: Outline GP perspectives on imaging studies obtained via the new "GP Access to Community Diagnostics" initiative. METHODS: A mixed-methods design was employed. Referrals over the first six months of 2019 and 2021 were collated by a private imaging provider, and a randomly selected subset of 2021 studies (maximum 30 referrals per GP) was returned to participating GPs to provide detail on the impact on each patient's care. In-depth qualitative interviews were also conducted with participating GPs. RESULTS: Eleven GPs supplied detailed information on 81 studies organized through the new initiative. GPs reported that the initiative had led to a large proportion of cases being managed solely in general practice, with an 81% reduction in referrals to acute hospital settings and a 58% reduction in referrals to secondary care clinics. GPs felt imaging studies improved patient care in 86% of cases and increased GP workload in 58% of cases. GP qualitative interviews revealed four key themes: improved patient care, increased GP workload, reduction in hospital referrals, and opinions on ongoing management of such initiatives, including guidelines. CONCLUSIONS: GPs felt enhancing access to diagnostics improved patient care by expediting diagnosis, decision-making, and treatment and by reducing hospital referrals. GPs were generally positive about the initiative and made some suggestions on future management of the initiative.

Impact of enhancing GP access to diagnostic imaging: A scoping review.

BACKGROUND: Direct access to diagnostic imaging in General Practice provides an avenue to reduce referrals to hospital-based specialities and emergency departments, and to ensure timely diagnosis. Enhanced GP access to radiology imaging could potentially reduce hospital referrals, hospital admissions, enhance patient care, and improve disease outcomes. This scoping review aims to demonstrate the value of direct access to diagnostic imaging in General Practice and how it has impacted on healthcare delivery and patient care. METHODS: A search was conducted of 'PubMed', 'Cochrane Library', 'Embase' and 'Google Scholar' for papers published between 2012-2022 using Arksey and O'Malley's scoping review framework. The search process was guided by the PRISMA extension for Scoping Reviews checklist (PRISMA-ScR). RESULTS: Twenty-three papers were included. The studies spanned numerous geographical locations (most commonly UK, Denmark, and Netherlands), encompassing several study designs (most commonly cohort studies, randomised controlled trials and observational studies), and a range of populations and sample sizes. Key outcomes reported included the level of access to imaging serves, the feasibility and cost effectiveness of direct access interventions, GP and patient satisfaction with direct access initiatives, and intervention related scan waiting times and referral process. CONCLUSION: Direct access to imaging for GPs can have many benefits for healthcare service delivery, patient care, and the wider healthcare ecosystem. GP focused direct access initiatives should therefore be considered as a desirable and viable health policy directive. Further research is needed to more closely examine the impacts that access to imaging studies have on health system operations, especially those in General Practice. Research examining the impacts of access to multiple imaging modalities is also warranted.

Subscapularis integrity, function and EMG/nerve conduction study findings following reverse total shoulder arthroplasty.

BACKGROUND: During reverse total shoulder arthroplasty, the functionality of the subscapularis remains unknown. The purpose of this study was to determine the integrity and function of the repaired subscapularis after reverse total shoulder arthroplasty using ultrasound, electromyography (EMG), and nerve conduction studies (NCS) to assess postoperative tendon healing, muscle, and nerve function. MATERIALS AND METHODS: Patients who underwent reverse total shoulder arthroplasty and repair with minimum 6-month follow-up were included in the study. Patient-reported outcome, physical examination, ultrasound examination of the subscapularis tendon, subscapularis EMG, and lower subscapular NCS were performed. In addition, contralateral subscapularis ultrasound, EMG, and lower subscapular nerve nerve NCS were performed to establish normative values (abnormal defined at >20% increased latency or >50% decreased amplitude). Phi coefficients of association and point biserial coefficients were used to correlate the ultrasound examination, EMG, and NCS results with the functional outcomes. RESULTS: A total of 20 patients were included. Four patients had abnormal but intact subscapularis tendons on ultrasound. Nine patients had abnormal lower subscapular NCS compared with the contralateral shoulder. All patients had normal subscapularis EMGs. No significant correlation was found between the ultrasound and NCS results. No significant correlations were found between the ultrasound or the NCS results and any of the independent outcome variables. CONCLUSION: This study demonstrates that the subscapularis remains neurologically functional after reverse total shoulder arthroplasty, based on EMG and NCS findings. Although side-to-side differences in lower subscapular NCS were identified in 45% of the postoperative shoulders, these abnormalities did not correlate with functional outcomes.