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Background: Inappropriate diagnostic imaging is a burgeoning problem within the Canadian healthcare system and imposes considerable burdens to efficiency and timeliness of care. Low back pain and headaches affect an immense portion of the general population and have become exceedingly common complaints from patients seeking diagnostic imaging from primary care physicians., Methods: A total of 399 magnetic resonance imaging (MRI) and computed tomography (CT) requisitions for lumbar and head scans were reviewed and assessed for appropriateness in concordance with published Choosing Wisely guidelines for head and lumbar diagnostic imaging. Requisitions were classified as appropriate, inappropriate, or incomplete. Baseline data collection showed 51.6% appropriateness, 12.0% inappropriateness, and 36.3% incompleteness. New patient-centered referral forms containing evidence-based red flags by Choosing Wisely Canada were created for head and lumbar MRI and CT. The aim was to increase awareness and consideration of the guidelines during the referral process. The new referrals were distributed among 149 local family physicians in addition to information pamphlets summarizing the need to reduce unnecessary diagnostic imaging for head and lower back pain., Results and Conclusion: After collection and review of 251 requisitions in the postintervention period, incomplete referrals dropped from 36.3% to 13.15%. Despite insignificant changes in appropriateness, it is promising that the intervention educated local physicians on the information required to complete the CT or MRI forms as further evidence is provided showing the efficacy of the patient-centered referrals. This study provides insight on the importance of appropriate diagnostic imaging and what methods can be used at the primary care level., (Copyright © 2019. Published by Elsevier Inc.)

Purpose: Diagnostic imaging (DI) at Niagara Health, like other hospitals, experiences challenges with patients who do not attend their scheduled appointments, resulting in a "no show." Reducing no show percentages presents an opportunity to improve upon wait lists within specific modalities such as magnetic resonance imaging (MRI) and to reduce the loss of productivity for this high-demand resource., Aim: To reduce the MRI no-show percent in DI at two community hospitals from 6.5% to 5% through patient engagement via mailed reminder letters and education at the primary care level., Methods: Our two-pronged approach included interventions at community hospitals and at the primary care level. Reminder letters were mailed to patients with their appointment time and other pertinent information to allow for an increased number of patients reminded about appointments and a second means of reminder. At the primary care level, an information package was sent to various independent physicians for distribution to patients requiring an MRI scan, outlining benefits of showing up to the scheduled appointment to educate patients and improve attendance at DI., Results: The mailing letter resulted in a significant reduction from 7.1% to 6.3% in overall no shows across two community hospitals (P = .04). The true effect of the letter was likely masked by increased wait times during the study period, which correlates with increased no-show percentages. The first trial of the information pamphlet among five practices for 1 month resulted in a nonsignificant reduction of no shows from 19% to 3% (P = .125). The second trial among 19 practices for 3 months led to a significant reduction of no shows from 7.7% to 4.2% (P = .007)., Conclusions: Both the methods, the mailing letter and patient-information pamphlet, provide promising results in regard to reducing the no-show percentage among patients seen in DI for MRI appointments., (Copyright © 2018. Published by Elsevier Inc.)