Point-of-Care Synchronous Virtual Radiology Consultations for Atherosclerotic Disease in Primary Care: A Cluster-Randomized Study

John C Panagides; Nikhita Nambiar; Garrett Chinn; Avinash Kambadakone; Susan Bennett; Evita Joseph; Dania Daye

doi:10.1016/j.jacr.2021.10.013

Point-of-Care Synchronous Virtual Radiology Consultations for Atherosclerotic Disease in Primary Care: A Cluster-Randomized Study

J Am Coll Radiol. 2022 Feb;19(2 Pt B):359-365. doi: 10.1016/j.jacr.2021.10.013.

Authors

John C Panagides¹, Nikhita Nambiar², Garrett Chinn³, Avinash Kambadakone², Susan Bennett³, Evita Joseph³, Dania Daye⁴

Affiliations

¹ Harvard Medical School, Boston, Massachusetts.
² Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
³ Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
⁴ Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Director, Precision Interventional and Medical Imaging Laboratory, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: ddaye@mgh.harvard.edu.

PMID: 35152961
DOI: 10.1016/j.jacr.2021.10.013

Abstract

Purpose: Synchronous virtual visits are an emerging model of care, and their feasibility has been demonstrated in radiology. The purpose of this study was to assess the value of point-of-care virtual radiology primary care consultations for atherosclerotic vascular disease management.

Methods: In this institutional review board-approved study, 107 age- and gender-matched patients were assigned to control (n = 62) and intervention (n = 45) arms with the following inclusion criteria: (1) age > 45 years, (2) consult with a primary care physician (PCP), and (3) recent CT of the chest or abdomen demonstrating atherosclerotic calcification. In the intervention arm, virtual real-time radiology consultation with referring PCPs and patients was conducted, with review of CT images focused on the extent of vascular atherosclerosis. Patients in the control arm followed the current standard of care of PCPs' discussing relevant imaging results, if any.

Results: Thirty-one patients in the intervention arm and 31 patients in the control arm completed the study (control: 64.5% women; mean age, 68 years; intervention: 67.7% women; mean age, 67 years). Discussion of imaging findings occurred with all patients in the intervention arm (discussion with PCP and virtual consultation with radiologist) and with 45% of patients in the control arm (PCP only; P < .001). All patients in the intervention arm indicated that seeing or discussing their images improved their understanding of their disease, compared with 85% of patients in the control arm (P = .04). In the intervention arm, 10 of 31 patients (32.2%) left the visit with changes in prescriptions for statins or antihypertensive medications, compared with only 4 of 31 patients (13%) in the control arm (P = .04).

Conclusions: Point-of-care radiology virtual visits enhance patient understanding and may influence the longitudinal management of atherosclerotic disease in primary care.

Keywords: Virtual visit; atherosclerosis; point of care; primary care.

Publication types

Randomized Controlled Trial

MeSH terms

Aged
Atherosclerosis* / diagnostic imaging
Atherosclerosis* / therapy
Female
Humans
Male
Middle Aged
Point-of-Care Systems
Primary Health Care
Radiology*
Referral and Consultation