Primary care physicians’ access to in-house ultrasound examinations across Europe: a questionnaire study

Abstract

ObjectiveThe overall objective of this study was to examine the differences in ultrasound availability in primary care across Europe.DesignCross-sectional study.SettingPrimary care.ParticipantsPrimary care physicians (PCPs).Primary and secondary outcomes measuresThe primary aim was to describe the variation in in-house primary care ultrasonography availability across Europe using descriptive statistics. The secondary aim was to explore associations between in-house ultrasonography availability and the characteristics of PCPs and their clinics using a mixed-effects logistic regression model.ResultsWe collected data from 20 European countries. A total of 2086 PCPs participated, varying from 59 to 446 PCPs per country. The median response rate per country was 24.8%. The median (minimum–maximum) percentage of PCPs across Europe with access to in-house abdominal ultrasonography was 15.3% (0.0%–98.1%) and 12.1% (0.0%–30.8%) had access to in-house pelvic ultrasonography with large variations between countries. We found associations between in-house abdominal ultrasonography availability and larger clinics (OR 2.5, 95% CI 1.2 to 4.9) and clinics with medical doctors specialised in areas, which traditionally use ultrasonography (OR 2.1, 95% CI 1.1 to 3.8). Corresponding associations were found between in-house pelvic ultrasonography availability and larger clinics (OR 1.9, 95% CI 1.3 to 2.7) and clinics with medical doctors specialised in areas, which traditionally use ultrasonography (OR 3.0, 95% CI 1.8 to 5.1). Additionally, we found a negative association between urban clinics and in-house pelvic ultrasound availability (OR 0.5, 95% CI 0.2 to 0.9).ConclusionsAcross Europe, there is a large variation in PCPs’ access to in-house ultrasonography and organisational aspects of primary care seem to determine this variation. If evidence continues to support ultrasonography as a front-line point-of-care test, implementation strategies for increasing its availability in primary care are needed. Future research should focus on facilitators and barriers that may affect the implementation process.

Use and impact of point-of-care ultrasonography in general practice: a prospective observational study

“…The influence of POCUS on patient treatment in general practice was estimated through: (1) change in plan for the patient; (2) change in patient's treatment; (3) the relationship between certain findings and changes in the management plan or treatment of the patient.…”

“…Based on a questionnaire study, 3 we estimate that there were around 75 GPs in Denmark, who would meet our inclusion criteria. We found it realistic to include 20 of the GPs in the study.…”

“…4 20 22-25 The evidence base for these attempts is sparse, however, and there may be significant differences between countries regarding which examinations are most relevant. 3 In addition, some examinations may be easier to master than others, 5 both in terms of achieving competence and in terms of maintaining competence over time. The latter may be particularly important in general practice where the frequency of some POCUS examinations is as low as shown in this study (figure 3).…”

“…Point-of-care ultrasound (POCUS) is used in general practice in several countries. [1][2][3][4] A recent systematic review found that few studies described the use of POCUS in the hands of the general practitioner (GP) and that obstetric, abdominal and heart examinations were the most commonly described. 5 The included studies, however, focused on selected scanning modalities and largely aimed to explore a possible transition of ultrasound examinations from secondary to primary care.…”

A cost-minimisation analysis of performing point-of-care ultrasonography on patients with vaginal bleeding in early pregnancy in general practice: a decision analytical model

“…the United Kingdom (UK) and Denmark, patients with vaginal bleeding in early pregnancy will consult their GP for evaluation and they will need a referral from the GP to see a gynaecologist. However, the accessibility and use of POCUS in primary care differs between countries [ 11 , 12 ]. In countries where POCUS is generally not accessible in general practice, the patients will be referred to a private gynaecological practice or a hospital gynaecology department for further evaluation following a clinical evaluation in general practice [ 13 , 14 ].…”