Ultrasound-guided injections in primary care: evidence, costs, and suggestions for change

Bee, William Wynter; Thing, James

doi:10.3399/bjgp17x692117

Cited by 8 publications

(8 citation statements)

References 3 publications

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“…Similarly, a meta-analysis conducted in 2011 reported the superiority of ultrasound to radiography in the detection of pneumothorax [31]; however, our survey findings show that only 35% of GPs utilize it for this purpose. Further, the application of ultrasound in the diagnosis of fractures or for procedural guidance, particularly in musculoskeletal and soft tissue injections, is relatively low in spite of the diagnostic accuracy and the cost effectiveness of ultrasound imaging in primary care for such indications [32,33]. It is possible that these conditions are not overly common across Swiss primary care and are more prevalent in emergency room settings, which may therefore explain this disparity.…”

Section: Interpretation and Comparison To Existing Literaturementioning

confidence: 99%

The use of ultrasound in primary care: longitudinal billing and cross-sectional survey study in Switzerland

Touhami

Merlo²,

Hohmann

et al. 2020

BMC Fam Pract

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Background Ultrasound imaging is utilized in Swiss primary care; however, little is known regarding the extent to which it is performed. With this study, we aim to (1) provide an overview of ultrasound use by general practitioners (GPs), and (2) determine the clinical indications of ultrasound in Swiss general practice. Methods This is a quantitative study, analyzing 15 years of billing data from 213 GPs in Central Switzerland, and cross-sectional survey data completed by 61 GPs attending 26 certification and refresher courses offered by the Swiss Society of Ultrasound in Medicine (SGUM). Results According to billing data, 49% of the GPs used ultrasound and provided 130,245 exams to 67,180 patients between 2004 and 2018. Over the years, ultrasound use became more frequent among GPs. Male GPs provide more ultrasound exams than female GPs. Patients that are female, ≥65 years, and multi-morbid had more ultrasound exams compared to males, patients < 65 years, and those with only one morbidity, respectively. GPs provided a mean of 129 ultrasound exams per physician-year. Abdominal ultrasound comprised almost 69% of all exams. According to survey data, indications covered many organ systems and clinical conditions, with abdominal indications being most frequent among them. Conclusions The use of ultrasound is high among general practitioners and it covers a wide range of clinical indications. Ultrasound is utilized primarily in the diagnosis of clinical indications of the abdomen, and more often for female than male patients.

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Section: Interpretation and Comparison To Existing Literaturementioning

confidence: 99%

The use of ultrasound in primary care: longitudinal billing and cross-sectional survey study in Switzerland

Touhami

Merlo²,

Hohmann

et al. 2020

BMC Fam Pract

View full text Add to dashboard Cite

show abstract

“…In addition, recent reduction in costs have made ultrasonography equipment financially feasible for most clinics. These beliefs are supported by Bee and Thing, 44 who propose that even a 1-to 2-day basic skills ultrasonographic course would be sufficient to train general practitioners to perform musculoskeletal ultrasonogram-guided joint and soft tissue injections. They also speculate that decreasing costs of POC ultrasound machines and the abundance of educational opportunities to train in musculoskeletal ultrasonography will precipitate a new paradigm where such a scenario is commonplace.…”

Section: Ultrasonography As a Clinical Tool To Enhance Safety Of Subcutaneous Immunotherapymentioning

confidence: 94%

Point-of-care ultrasonography in the allergy and immunology clinic

Jeimy

Wong-Pack

Veettil

et al. 2019

Annals of Allergy, Asthma & Immunology

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Point of care clinical ultrasonography is used across multiple medical specialties to guide diagnosis and treatment and to enhance the safety of invasive procedures.In allergy and immunology, point-of-care ultrasonography is underused.The standard epinephrine autoinjector (EAI) needle length may be inadequate for intramuscular delivery of epinephrine, particularly for women at risk of anaphylaxis. Ultrasonography can identify the need for longer EAI needle lengths to compensate for increased skin to muscle depth attributable to increased subcutaneous tissue in this patient population.Conversely, for pediatric patients, the lengths of commercially available EAIs lengths may be too long, risking inadvertent intraosseous injection and resultant complications. Ultrasonography can evaluate skin to bone depth in these patients, which may require adjustment to epinephrine administration.Point-of-care ultrasonography can also be used in needle guidance for subcutaneous allergen immunotherapy injections to reduce the chance of inadvertent intramuscular injection and systemic adverse effects.

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“…Moreover, the application of ultrasound in the diagnosis of fractures or for procedural guidance, particularly in musculoskeletal and soft tissue injections, is relatively low in spite of the diagnostic accuracy and the cost effectiveness of ultrasound imaging in primary care for such indications [31,32]. It is possible that these conditions are not overly common across Swiss primary care and are more prevalent in emergency room settings, which may therefore explain this disparity.…”

Section: Main Findingsmentioning

confidence: 99%

The use of ultrasound in primary care: Longitudinal billing and cross-sectional survey study in Switzerland

Touhami

Merlo

Hohmann

et al. 2020

Preprint

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Abstract Background Ultrasound imaging is utilized in Swiss primary care; however, little is known regarding the extent to which it is performed. A course in Point-of-Care ultrasound (POCUS) has been recently introduced to promote and improve the utilization of ultrasound. POCUS will offer faster certification compared to previous courses thanks to a limited set of targeted examinations. With this study, we aim to (1) provide an overview of ultrasound use by general practitioners (GPs), and (2) determine how the clinical uses of ultrasound relate to the targeted objectives of POCUS. Methods This is a quantitative study, analyzing fifteen years of billing data from 213 GPs in Central Switzerland and cross-sectional survey data completed by 61 GPs attending 26 certification and refresher courses offered by the Swiss Society of Ultrasound in Medicine (SGUM). Results According to billing data, 49% of the GPs used ultrasound and provided 130,245 exams to 67,180 patients between 2004 and 2018. Over the years, ultrasound use became more frequent among GPs. Male GPs provide more ultrasound exams than female GPs. Patients that are female, ≥65 years, and multi-morbid had more ultrasound exams compared to males, patients <65 years, and those with only one morbidity, respectively. GPs provided a mean of 129 ultrasound exams per physician-year. Abdominal ultrasound comprised almost 69% of all exams. According to survey data, indications covered many organ systems and clinical conditions, with most POCUS indications being among them. Conclusions Utilization of ultrasound is high among general practitioners and covers a wide range of indications. A focus in certification on POCUS might reduce the variety of indications. Keywords: Ultrasound; general practice; primary care; general practitioners; clinical indications; POCUS; ultrasound certification; Switzerland

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Ultrasound-guided injections in primary care: evidence, costs, and suggestions for change

Cited by 8 publications

References 3 publications

The use of ultrasound in primary care: longitudinal billing and cross-sectional survey study in Switzerland

The use of ultrasound in primary care: longitudinal billing and cross-sectional survey study in Switzerland

Point-of-care ultrasonography in the allergy and immunology clinic

The use of ultrasound in primary care: Longitudinal billing and cross-sectional survey study in Switzerland

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