You can find points for reflection in your individual report if you have received one, or in the sample report.

Key points

  • Reflect on your practice and your requests for imaging of the low back
  • Reflect on your data in relation to your patients and their indications for imaging
  • Access a sample report

About the Practice Review

The Practice Review is a four-page report regularly mailed to GPs in Australia. Its purpose is to support you in your professional development and quality improvement. Each report focuses on a specific clinical area and includes:

  • background information about the clinical area of focus
  • your individual utilisation of MBS tests or dispensing data for PBS medicines
  • evidence-based points for reflection
  • aggregate data of GPs working in similar practices across Australia for comparison
  • additional data from the MedicineInsight general practice database to provide insights into the condition/s for which medicines or tests have been requested; this provides context to help you further interpret your data

Download and print a sample report

How have your requests for lumbosacral imaging changed over time?

In the financial year 2017–18, 12 of your patients received a lumbosacral X-ray and 9 of your patients received a lumbosacral CT scan

 

My data do not look as I’d expect, why could this be?

Data represents lumbosacral X-rays and CT scans that you requested and that were performed. If your numbers are lower than you expect, it may be that:

  • you are requesting lumbosacral images, but your patients are not having them performed.

If your numbers are higher than you expect, it may be that:

  • you requested lumbosacral images before the financial year 2017–18, but your patients had them performed during the financial year 2017–18

Help me reflect on my data

  • What factors do I consider when referring a patient for a lumbosacral image?
  • Of my patients who received a lumbosacral image, how many had one or more alerting features (red flags) that made me suspect a potentially serious spinal pathology?
  • How do I manage patients who expect an image of their lower back when it is not clinically indicated?

Figure 1: Lumbosacral X-rays over time

Read an accessible version of Figure 1


Figure 2: Lumbosacral CT scans over time

Read an accessible version of Figure 2

What do these graphs show me?

  • Figure 1 shows the total number of lumbosacral X-rays that you requested and that were performed, expressed as a rate per 1000 patients.
  • Figure 2 shows the total number of lumbosacral CT scans that you requested and that were performed, expressed as a rate per 1000 patients.
  • The request rate per 1000 patients is shown for financial years 2014–15, 2015–16, 2016–17, 2017–18.
  • Numbers have been adjusted to represent a rate per 1000 patients to provide relative comparisons with the median GP in your RA. 
  • The purpose of this graph is to show you the trend in your requests for imaging of the low back over time compared to your peers.

I have an asterisk on my graph, what does this mean?

  • An asterisk on a column in the graph indicates that your data for that year are above the range that can be represented in the graph.
  • This graph is scaled to fit 90% of the data from all GPs.


My data do not look as I’d expect. Why could this be?

The graphs represent the number of lumbosacral X-rays or CT scans as a rate per 1000 patients to allow comparison between GPs with varying numbers of patients.

If your requests for lumbosacral X-rays or CT scans are higher than you expect, this may be because:
  • your total number of patients is lower than average.
    For example, if you
    - requested 5 lumbosacral X-rays in 2017–18
    - have 500 patients in total for that financial year
    then the rate of your lumbosacral X-rays per 1000 patients (green bar) = (5/500) * 1000 = 10
  • you requested an X-ray or CT scan prior to the financial year 2017-18, but your patients had them performed during the financial year 2017–18.
If your requests for lumbosacral X-rays or CT scan are lower than you expect, this may be because: 
  • your total number of patients is higher than average.
    For example, if you:
    - requested 6 lumbosacral X-rays in 2017–18
    - have 2000 patients in total for that financial year
    then the rate of your lumbosacral X-rays per 1000 patients (green bar) = (6/2000) * 1000 = 3
  • you are requesting X-rays and/or CT scans, but your patients are not having them performed.

Help me reflect on my data

  • Have my requests for lumbosacral imaging changed over the last 4 years?
  • What are the reasons my imaging requests may have changed?
  • Am I requesting more images of the low back than my peers?
  • What is my approach to diagnosing low back pain as non-specific?

What does MedicineInsight tell us? 

MedicineInsight data show that of all patients with low back pain, 41% received an X-ray, 56% received a CT scan and 20% received an MRI.

  • How does this data compare to your estimate of patients who received an image of their lower back?

Aggregate MedicineInsight data as at 1 September 2018. Request for low back imaging and reference to relevant indication must be in the 12 months before this date.

Who did you request a lumbosacral image for in 2017–18?

Figure 3: Age and gender of your patients who had lumbosacral imaging

Read an accessible version of Figure 3

What does this graph show me?

  • This graph shows the age distribution of your patients who received an image of their lower back in the financial year 2017–18.
  • Data is shown for the age groups 10–29 years, 30–44 years, 45–59 years, 60–74 years and 75+ years
  • The number of patients in each age group is shown as a percentage of all patients who received a lumbosacral X-ray or CT scan.
  • Within each age group, percentage of patients who were male (purple bar) and female (orange bar) are shown.
  • The purpose of this graph is to provide you with more data about your patients who received a lumbosacral X-ray or CT scan in 2017–18.

Help me interpret and reflect on my data

  • What is my overall patient demographic (eg, older or younger patients)? Does this affect the number people I see with low back pain?
  • When do I consider referring a patient with low back pain for imaging?
  • How do I discuss a diagnosis of non-specific low back pain with my patients?

Age profile of patients in your practice

Figure 4: Age profile of your patients

Read an accessible version of Figure 4

What does this graph show?

  • This graph shows the breakdown by age group of the total number of your patients who received a category 1 (ie, professional attendances) or category 5 (diagnostic imaging services) Medicare benefit between 1 July 2017 and 30 June 2018.
  • The purpose of this graph is to give you a snapshot of your patients to help you interpret your data. 
  • The shaded blue area lies between the 25th and 75th percentile for the age profiles of patients of GP practices in your RA.
  • Your RA peer group is identified.

I have an asterisk on my graph. What does this mean?

  • An asterisk on the age profile graph indicates that your data is above the range that can be represented in the graph, ie, you have more than 800 patients in the age group above which the asterisk has been placed.
  • This graph is scaled to fit 90% of the data from all GPs.

Your Medicare patients and concession card holders

Table 1: Your Medicare patients and concession card holders

Read an accessible version of Table 1

What does this table show?

  • This table shows the total number of unique patients that you have seen over a standard 3-month period.
  • The table gives the total number of patients who received a category 1 (ie, professional attendances) or category 5 (diagnostic imaging services) Medicare benefit, and the total number of patients who used a concession card or safety net card to have a prescription written by you dispensed.
  • The purpose of this table is to provide you with a snapshot of your patients to help you interpret some of the data presented in the graphs and tables in this report.
  • This information is from 1 April 2018 to 30 June 2018.
  • The median for GPs in your RA is also provided.

Frequently asked questions