Which factors determine the use of diagnostic imaging technologies for gastrointestinal complaints in general medical practice

Objective: Even though gastrointestinal complaints are among the most frequent reasons to contact general medical practioners, little is known about the actual care of these patients, especially the use of diagnostic imaging technologies. Methods: In a network of 57 family practitioners and 29 general internists in Lower Saxony, Germany, 1,217 contacts with patients with gastrointestinal diseases (16%, gastritis; 12%, gastroenteritis; 6%, cholelithiasis; 5% each, ulcus ventriculi and duodeni, and 14%, no final diagnosis) were documented. The effects of patient and physician/practice side factors on the use of ultrasonography and radiography were modeled using multivariate logistic regression. Results: For ultrasonography, diagnosis and ownership of an ultrasound unit (odds ratio [OR] = 3.33) were highly significant predictors (p <.0001), followed by unknown diagnosis at beginning of contact (OR = 1.92; p =.0019), physician specialty (OR for internists = 1.89; p =.0025), and severity (p = .0085). For radiography, ownership of an ultrasound unit was the most significant factor (OR = 0.34; p <.0001), followed by severity (p <.0009), ownership of x-ray apparatus (OR = 2.56; p =.0025), physician specialty (OR for internists = 1.98; p =.0358), and unknown diagnosis at beginning of contact (OR = 1.79; p =.0451). Not significant were age and sex of patient and diagnosis for radiography. Conclusions: Physicians use diagnostic imaging technologies for patients with gastrointestinal complaints according to severity and knowledge about the diagnosis, but ownership of technology is the most predictive factor.