Strategies to optimize management of incidental radiographic findings in the primary care setting: A mixed methods study

Stephanie D Talutis; Ellen Childs; Anna L Goldman; Philip E Knapp; Avneesh Gupta; Cleopatra Ferrao; Timothy Feeney; David McAneny; Frederick Thurston Drake

doi:10.1016/j.amjsurg.2021.03.038

Strategies to optimize management of incidental radiographic findings in the primary care setting: A mixed methods study

Am J Surg. 2022 Feb;223(2):297-302. doi: 10.1016/j.amjsurg.2021.03.038. Epub 2021 Mar 25.

Authors

Stephanie D Talutis¹, Ellen Childs², Anna L Goldman³, Philip E Knapp³, Avneesh Gupta⁴, Cleopatra Ferrao³, Timothy Feeney¹, David McAneny¹, Frederick Thurston Drake⁵

Affiliations

¹ Boston University School of Medicine, Department of Surgery. Boston, MA, USA; Boston Medical Center, Boston, MA, USA.
² Boston University School of Public Health, Boston, MA, USA; Abt Associates, Rockville, MD, USA.
³ Boston Medical Center, Boston, MA, USA; Boston University School of Medicine, Department of Medicine. Boston, MA, USA.
⁴ Boston Medical Center, Boston, MA, USA; Boston University School of Medicine, Department of Radiology. Boston, MA, USA.
⁵ Boston University School of Medicine, Department of Surgery. Boston, MA, USA; Boston Medical Center, Boston, MA, USA. Electronic address: Frederick.Drake@bmc.org.

PMID: 33810834
DOI: 10.1016/j.amjsurg.2021.03.038

Abstract

Background: Incidental adrenal masses (IAMs) are common. Primary care providers (PCPs) are frequently responsible for incidentaloma evaluations. We evaluated whether PCPs view this paradigm effective, barriers faced, and strategies to optimize care delivery.

Methods: This is a sequential explanatory study, comprised of surveys followed by focus groups of PCPs. Because lung nodules are another type of common incidental finding, we compared PCP views on management of lung nodules to their views on IAMs.

Results: For IAMs, 22.3% of PCPs "always refer" to specialists, but for lung nodules this was 11.5% (p = 0.026). For lung nodules, the most significant barrier was insufficient time/support to longitudinally follow results (69%), but for IAMs it was uncertainty about which tests to order (68%). Fear of litigation was equal (lung = 22.5%, IAMs = 21.3%). Consistent themes regarding the "ideal" system included specific recommendations in radiology reports; automation of orders for follow-up tests; longitudinal tracking tools; streamlined consultations; and decision guides embedded within the electronic health record.

Conclusions: Respondents are more comfortable with lung nodules than IAMs. Management of "incidentalomas" is within their scope of practice, but the current system can be optimized.

Keywords: Adrenal gland; Adrenal incidentaloma; Care coordination; Endocrine surgery; Mixed methods study; Primary care.

MeSH terms

Humans
Incidental Findings*
Lung
Primary Health Care
Referral and Consultation*
Specialization