RT Journal Article SR Electronic T1 Associations between general practice characteristics and chest x-ray rate: an observational study JF British Journal of General Practice JO Br J Gen Pract FD British Journal of General Practice SP BJGP.2021.0232 DO 10.3399/BJGP.2021.0232 A1 Stephen H Bradley A1 Matthew Barclay A1 Benjamin Cornwell A1 Gary A Abel A1 Matthew Callister A1 Mayam Gomez-Cano A1 Thomas Round A1 Bethany Shinkins A1 Richard Neal YR 2021 UL http://bjgp.org/content/early/2021/10/21/BJGP.2021.0232.abstract AB Background: Chest x-ray (CXR) is the first-line test for lung cancer in many settings. Previous research has suggested that higher utilisation of CXR is associated with improved outcomes. Aim: To explore the associations between characteristics of general practices and frequency of investigation with CXR. Design & Setting: Retrospective observational study of English general practices. Method: We constructed a database of English general practices containing number of CXRs requested and data on practices for 2018, including patient & staff demographics, smoking prevalence, deprivation and patient satisfaction indicators. Mixed effects Poisson modelling was used to account for variation due to chance and to estimate the amount of remaining variation that could be attributed to practice and population characteristics. Results: There was substantial variation in GP CXR rates (median 34 per 1000 patients, IQR 26-43). Only 18% of between-practice variance in CXR rate was accounted for by recorded characteristics. Higher practice scores for continuity and communication skills and higher proportions of smokers, Asian and mixed ethnic groups, and patients aged >65 were associated with increased CXR rates. Higher patient satisfaction scores for access and with greater proportions of male and patients of black ethnicity were associated with lower CXR rates. Conclusion: Substantial variation was found in CXR rates beyond that expected by chance, which could not be accounted for by practices’ recorded characteristics. Since other research has indicated that increasing CXR rates can lead to earlier detection, supporting practices which currently investigate infrequently could be an effective strategy to improve lung cancer outcomes.