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GPs get MRI go-ahead, but not for lower backs

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General practitioners can now directly refer adult patients for magnetic resonant imaging of the head, neck and knee after the Federal Government signed off on recommendations from a group of medical experts, but GPs are still being denied the ability to order scans for those with lower back pain.

In a move welcomed by the AMA, Health Minister Peter Dutton announced on 1 November that $75 million had been allocated over two years to enable GPs to directly request Medicare-rebated MRI scans for head, neck and knee complaints in patients older than 16 years, rather than having to refer patients to a specialist first. It follows the introduction a year ago of GP-referred MRI items for patients younger than 16 years.

Mr Dutton said the change meant patients could receive a Medicare rebate for four different types of MRI services without having to go to the cost or inconvenience of seeing a specialist or consultant physician first, and would also reduce potential radiation exposure.

“The availability of these items should help reduce the need for patients to be exposed to radiation which is associated with other types of diagnostic imaging, like computed tomography (CT) scans,” the Minister said.

AMA President Dr Steve Hambleton said it was an important decision which would improve patient care and save the health system money.

“[Until now] GPs [have] effectively been denied direct access to the best available technology for their patients,” Dr Hambleton said. “These new items will improve access to care, reduce costs to the health system, and provide further support for GPs to provide better care for their patients.”

 Under the change, GPs can order a head MRI for patients suffering unexplained seizures or chronic headaches with suspected intracranial pathology; a knee MRI for cases of suspected acute tears of the meniscus or anterior cruciate ligament; and spinal MRIs to investigate cases of suspected cervical spine trauma or cervical radiculopathy.

Chair of the AMA Council of General Practice Dr Brian Morton said the new MRI items were a “good first step”, but more needed to be done to ensure patients had access to the best available care.

Dr Morton said GPs were still being denied the ability to directly refer patients suffering lower back pain for an MRI, despite it being one of the most common presentations they saw.

He said that while the ability to request MRI scans of the head, knee and neck was useful, the area where it would be of greatest benefit would be in the diagnosis of lower back complaints.

The Health Department has flagged that there will be a review of diagnostic imaging for lower back pain, but the timing and conduct of the inquiry is yet to be announced.

Dr Morton said it was disappointing that the AMA had not been included in the working group advising on GP requested MRI items for adults, after contributing to deliberations that led to the creation of similar items for children.

Other medical organisations are also worried about the delay in giving GPs the ability to request MRIs for patients with lower back pain.

It is understood that the Royal Australian and New Zealand College of Radiologists has voiced concerns that patients who would benefit from an MRI scan are instead being examined using CT scans, exposing them unnecessarily to extra doses of radiation.

Dr Morton said it appeared the decision to delay GP authority to request MRI scans for patients with lower back pain was due purely to money.

“It is short sighted to attempt to restrict use of a safer and more appropriate imaging modality on the basis of non-clinical (cost) reasoning,” he told the Health Department.

“The reality of practice is that referral to a specialist in a particular discipline, in most cases where imaging is required, results in the ordering of an MRI.

“The cost to the patient and Medicare is greater than had the MRI been performed prior to the referral, and that also translates to better access to, and efficiency of, that specialist discipline for which waiting time[s] can be significant.”

The Royal Australian College of General Practitioners has developed clinical guidance for GPs considering referring adult patients for an MRI scan.

The guide advises that “GPs should be cautious in the decision to use MRI. Clinical history and physical examination are keys to advising patients about appropriate imaging”.

The College said the advice given in the guide was based on the premise that MRI was an “adjunct to patient management, not as a first-line diagnostic tool”.

The guide can be viewed at: http://www.racgp.org.au/download/Documents/Guidelines/clinical-guidance-for-mri-referral.pdf

Adrian Rollins