Community-acquired pneumonia - use of chest x-rays for diagnosis in family practice

According to guidelines, the diagnosis of pneumonia should be confirmed by chest x-ray, ensuring appropriate management and wise use of antibiotics. Our study aimed to describe use of x-rays by family doctors and patients following diagnosis of pneumonia in primary care practices in the north of Israel.

This was a retrospective database study including adults diagnosed with pneumonia, assessing rates of referral and actual use of chest x-rays. We examined rates of referral for chest x-rays and rates of adherence to the referral, according to age, gender, smoking status, comorbidities and distance of residence from the radiology facility.

During one year there were 4,230 diagnosed cases of pneumonia in the practice, of which 2,503 were referred for chest x-rays, and 1,920 adhered to the referral (45% of those diagnosed with pneumonia). The rate of referral was higher when the radiology facility was located in the same city as the family doctor compared to outside the city (69.7% and 53.2%, p < 0.001). Patients aged 40-64 were referred more than patients aged 18-39 or 65+ (61.5% vs. 56.5% and 58.3%, p = 0.03). Actual use of chest x-rays (considering both referral and adherence) was more likely when the radiology facility was in the same health centre or city than when it was outside the city [OR = 2.4; 95% CI: 2.1-2.8]; patients aged 65 + or 40-64 were more likely to adhere to the referral for x-ray than those aged 18-39 [OR = 1.3; 95% CI: 1.1-1.6, OR = 1.2; 95% CI: 1.0-1.4, respectively].

Accessibility of radiology facilities seems to be an important factor associated with both doctors' decisions and patients' adherence to the referral for chest x-rays.