Most general practitioners rarely order imaging for patients who have lower-back pain without severe symptoms. In this regard, the Netherlands scores better than other Western countries, like Canada and the United States. Only 8% of all general practitioners regularly order imaging. This is not recommended by the guidelines, because such imaging does not contribute to the treatment. This is indicated by the results of a study conducted by Radboud university medical center, the Leiden University Medical Center and the VGZ Cooperation.

The researchers used data from VGZ to examine how often certain types of care occur, even though the guidelines advise against them. Only 8% of all general practitioners order imaging at least once per week. The data also indicate that three fourths of all patients with spinal hernias receive MRI scans without surgery. According to the guidelines for neurosurgeons, MRI scans are useful in preparation for surgery, but they should be used with reservation in other cases. The abnormalities that can be revealed by MRI scans are generally unrelated to the pain experienced by the patient. Moreover, the treatment remains the same.

The lead researcher, Tijn Kool, who is affiliated with IQ Healthcare at Radboudumc explains, “We demonstrate that most general practitioners abide by the guidelines and that there is room for improvement amongst a segment of physicians with regard to the use of imaging in case of lower-back pain, particularly with regard to MRI in case of hernia.” According to Kool, this study identifies areas in which care could become more focused. He continues, “Professional associations and hospitals can encourage physicians to stop ordering these tests. It is also important for patients to learn that imaging is often unnecessary in case of back pain. This could reduce unnecessary further testing and radiation exposure for patients. Doing fewer of these tests would also reduce costs and avoid unnecessary burden on healthcare personnel.”

This study was conducted within the framework of the Doen of Laten? program, which guides physicians and nurses in reducing unsuitable care. In this program, hundreds of healthcare providers in general practitioners’ offices and hospitals are working to achieve more suitable care. Doen of Laten? is a program of the Citrien Fund. Coordinated by the university medical centers, the project is aimed at ensuring the right care with the right information in the right place.

Publication in European Journal of Public Health 
Assessing volume and variation of low-value care practices in the Netherlands
Rudolf B Kool, Eva W Verkerk, Jill Meijs, Niels van Gorp, Martijn Maessen, Gert Westert, Wilco Peul, Simone van Dulmen.