Healthcare Disparities in Interventional Radiology

A cross-sectional study assessing the role of interventional radiology services in regional and remote Australia

INTRODUCTION

It is estimated that 8% of hospitalised patients require treatment from Interventional Radiology (IR). However, little is known about the potential impact of IR on regional and remote Australians, including Indigenous patients. This study aimed to assess treatments performed by IRs on regional/remote patients to predict future IR workforce and governance needs.

METHODS

Single-centre cross-sectional study at a tertiary Victorian hospital. Patients were identified when they had an advanced IR treatment between 1 January 2022 and 2024. Basic procedures such as biopsy and drain insertion were not included. The primary outcome was the type and volume of IR treatments performed on patients who were transferred from a regional or remote home location for treatment.

RESULTS

Of 3485 advanced IR interventions, 908 procedures (26.0%) from patients who lived in a regional or remote location were included with 36.5% female, of mean age 55.6 years (SD 17.9). 1.4% identified as Indigenous which is similar to the Indigenous population incidence in Victoria of 1.0%. Of this group, 350 (38.5%) were either a day procedure, overnight elective admission, or simple inpatient procedure which could have been performed in a regional centre, which included 1.1% Indigenous patients.

CONCLUSION

There is an unmet need for IR services in regional and remote Australia, with many patients being transferred to our metropolitan centre for treatment that could be performed in regional IR hubs. This data will be important to drive government and hospital planning including capital infrastructure, workforce modelling and future recognition of IR as a new specialty in Australia.

Noncompliance with Guidelines on the Use of Ultrasound and Pentoxifylline in the Treatment of Venous Ulcers in a Rural Health Care System

Guidelines based on randomized controlled data recommend patients with newly diagnosed venous leg ulcers (VLUs) to undergo venous reflux duplex ultrasound (US) and be considered for treatment with pentoxifylline to accelerate ulcer healing. A retrospective review was conducted of 2,061 patients with VLU diagnosed between 2011 and 2020 in a rural health care system to identify factors associated with increased or decreased likelihood of being prescribed venous reflux duplex US and pentoxifylline. Venous reflux duplex US (16%) and pentoxifylline (0.7%) were prescribed infrequently. Evaluation by a vascular specialist was associated with a significantly increased frequency of undergoing venous reflux duplex US (5%-38%). Seeing a wound care specialist was associated with an increased frequency of being prescribed pentoxifylline (0.7%-1.4%). Increased referral to specialists and/or referring clinician education on guideline-based care may be of benefit to patients with VLUs. Pentoxifylline seems underused, even by specialists. Further study is needed to confirm these findings and determine whether they are generalizable.

Fostering Patient-Centered Equitable Care in Radiology: AJR Expert Panel Narrative Review

Patient-centered care (PCC) and equity are two of the six core domains of quality health care, according to the Institute of Medicine. Exceptional imaging care requires radiology practices to provide patient-centered (i.e., respectful and responsive to individual patient preferences, needs, and values) and equitable (i.e., does not vary in quality on the basis of gender, ethnicity, geographic location, or socioeconomic status) care. Specific barriers that prevent the delivery of patient-centered equitable care include information gaps, breaches of trust, organizational medical culture, and financial incentives. Information gaps limit practitioners in understanding the lived experience of patients. Breaches of trust prevent patients from seeking needed medical care. Organizational medical cultures may not be centered around patient experiences. Financial incentives can impede practitioners' ability to spend the time and resources required to meet patient goals and needs. Intentional approaches that integrate core principles in both PCC and health equity are required to deliver high-quality patient-centered imaging care for diverse patient populations. The purpose of this AJR Expert Panel Narrative Review is to review the origins of the PCC movement in radiology, characterize connections between the PCC and health equity movements, and describe concrete examples of ways to foster patient-centered equitable care in radiology.

Geospatial and Socioeconomic Disparities in Access to Interventional Radiology Care in the United States

PURPOSE

To determine and analyze the geographic distribution of interventional radiologists in the United States to identify populations that have decreased accessibility to IR care.

METHODS

The Society of Interventional Radiology public database was reviewed for board-certified interventional radiologists in all cities within the United States. US Census data was used to acquire county-level data sets on poverty, population, unemployment, median household income, education, and racial diversity. Odds ratios were calculated for access to IR care between the 75th and 25th percentile for each population variable. Counties with IRs were compared to counties without for each variable via t-Tests. QGIS was used to map the distribution of IRs.

RESULTS

2989 board-certified US interventional radiologists were found to be operating in 15.5% (n=487) of all counties. Almost a third of the country's population (31.2%) did not have access to an interventional radiologist within their county. The mean interventional radiologist:population ratio was 0.305 per 100,000 people. The average median income among counties with IRs was greater at $67,649 compared to $53,528 among counties without (P<0.05). In addition, an average of 31.3% of the population had a college degree in counties with IRs versus 20.3% in other counties (P<0.001). Higher average percentages of African Americans, Pacific Islanders, and Hispanics were observed in counties with IRs at 13.1%, 0.232%, and 13.7%, respectively (P<0.05).

CONCLUSION

Interventional radiologists are disproportionately distributed, with higher densities practicing near urban areas. Access is also limited to counties with higher incomes and a greater percentage of citizens with college education.