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Implementing direct access to low-dose computed tomography in general practice--method, adaption and outcome.

Louise Mahncke Guldbrandt1, Torben Riis Rasmussen2, Finn Rasmussen3

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Direct access to low-dose computed tomography (LDCT) in general practice identified lung cancer in 2.3% of patients, often at an early stage. Continuing Medical Education participation increased CT scan referrals for lung cancer diagnosis.

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Area of Science:

  • Oncology
  • Radiology
  • Primary Care Medicine

Background:

  • Early lung cancer detection significantly impacts patient prognosis.
  • Chest radiographs are standard for general practitioners (GPs) but have limitations; computed tomography (CT) offers higher sensitivity.
  • Implementing direct access to low-dose CT (LDCT) from general practice aims to improve early diagnosis.

Purpose of the Study:

  • To describe the implementation of direct access to LDCT for general practice referrals.
  • To evaluate the diagnostic yield and stage distribution of lung cancers detected via LDCT initiated in primary care.
  • To assess the impact of Continuing Medical Education (CME) on LDCT utilization by GPs.

Main Methods:

  • A cohort study nested within a randomized trial involving 119 general practices and 266 GPs.
  • GPs were randomized into groups, with intervention GPs offered direct access to chest LDCT and CME on lung cancer diagnosis.
  • Data collected over a 19-month period on patient referrals, diagnostic work-up, and cancer detection.

Main Results:

  • 648 patients were referred for LDCT, with 2.3% diagnosed with lung cancer, predominantly in a localized stage (60%).
  • Half of the referred patients required further diagnostic work-up.
  • GP referral rates for LDCT were 61% higher among CME participants, and CME-participating GPs diagnosed lung cancer 2.2 times more frequently through fast-track evaluation.

Conclusions:

  • Direct access LDCT in primary care identified lung cancer in 2.3% of referred patients, with a favorable early-stage distribution.
  • Half of patients required additional diagnostic procedures.
  • Participation in CME was associated with increased CT scan use and higher rates of early-stage lung cancer diagnosis. Further randomized trials are needed to confirm benefits on patient outcomes.