Point-of-care ultrasonography in Norwegian out-of-hours primary health care

Abstract

ObjectiveThe objective of this study is to determine the extent of ultrasound availability in Norwegian casualty clinics and estimate the prevalence of its use.DesignA retrospective study based on a national casualty clinic registry and data from reimbursement claims.SettingOut-of-hours primary health care in Norway.SubjectsAll Norwegian casualty clinics in 2016 and reimbursement claims from 2008 to 2015.Main outcome measuresPercent of casualty clinics with ultrasound, types of ultrasound devices and probes, reasons for/against ultrasound access, characteristics of clinics with/without ultrasound, frequency of five ultrasound indications and characteristics of the physicians using/not using ultrasound.ResultsOut of 182 casualty clinics, 41 (23%) reported access to ultrasound. Mobile (49%) and stationary (44%) devices were most frequent. Physician request was the most common cited reason for ultrasound access (66%). Neither population served by the casualty clinic nor distance to hospital showed any clear association with ultrasound access. All of the five ultrasound reimbursement codes showed a substantial increase from 2008 to 2015 with 14.1 ultrasound examinations being performed per 10,000 consultations in 2015. Only 6.5% of physicians performed ultrasound in 2015 and males were significantly more likely to use ultrasound than females (OR 1.85, 95% CI: 1.38–2.47, p < .001), even when adjusted for age, speciality status and geography.ConclusionsAlthough the use of ultrasound is increasing in out-of-hours Norwegian primary health care, most casualty clinics do not have access and only a minority of physicians use ultrasound.

Point-of-care ultrasound (POCUS) in Norwegian general practice

“…There was no observed gender difference between GPs in terms of number of scanning GPs. These results differ from the results described by Myhr et al in out-of-hours clinics [16], where 74% of scanning GPs were men. The difference may be explained by more male GPs working out-of-hours.…”

“…We observed 16% of Norwegian GPs claiming reimbursement for 2012, which confirms the first observation. A study of Norwegian out-of-hours practices in 2016 reported that 23% of practices had POCUS available [16], with 6.5% of physicians scanning in comparison to 30% during office hours. The discrepancies in scanning among physicians between regular office hours and out-of-hours practice cannot be explained by our study.…”

“…Several previous studies have addressed various aspects of POCUS in general practice, including assessing its use in out-of-hours primary health care [16], and education [4][5][6]8,17], measuring quality of scanning by GPs [4][5][6][7][8]11,12,17,18], the number of scans in various countries [4,8,16] and financial aspects [4][5][6]8,[16][17][18]. No study has addressed the development of scanning in general practice for the entire population of GPs in a country.…”

Point-of-care ultrasound in primary care: a systematic review of generalist performed point-of-care ultrasound in unselected populations

“…In Norway, 23% of emergency primary care centres had access to their own ultrasound machines in 2015. However, only 1 of 15 of the GPs working there used ultrasound ever and only 0.3% of billings included an ultrasound item [13]. Ultrasound was in 2014 commonly used in Germany (about 45%) and Greenland (about two-thirds), while it was less commonly used in Sweden, Denmark, Austria, and Catalonia (< 1%) [14].…”

Point-of-Care Abdominal Ultrasonography (POCUS) on the Way to the Right and Rapid Diagnosis

“…In emergency departments, abdominal pain is the third most common indication of POCUS [ 5 , 6 , 7 , 8 , 9 ]. Acute abdomen is a sudden onset of abdominal pain that requires immediate medical attention [ 10 ], but is also a major diagnostic challenge with many differential diagnoses that can range from self-limiting illnesses to life-threatening conditions [ 11 , 12 ].…”