Abstract
Objective The overall objective of this study was to examine the differences in ultrasound availability in primary care across Europe. Design Cross-sectional study. Setting Primary care. Participants Primary care physicians (PCPs). Primary and secondary outcomes measures The 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. Results We 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). Conclusions Across 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.
| Original language | English |
|---|---|
| Article number | e030958 |
| Pages (from-to) | 1-8 |
| Number of pages | 8 |
| Journal | BMJ Open |
| Volume | 9 |
| Issue number | 9 |
| Early online date | 30 Sept 2019 |
| DOIs | |
| Publication status | Published - 30 Sept 2019 |
Bibliographical note
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.Funding
PCPs’ access to in-house ultrasonography in primary care across Europe varied from 0% to 98% for AbdUS, and 0% to 31% for PelUS. While in-house ultrasonography might be an important tool to ensure faster and more correct diagnosis in primary care, in every country except Germany it was available to less than half of our PCP respondents. As evidence continues to support point-of-care ultrasonography as a front-line test, implementation strategies for the increased availability of the technology in primary care are needed. Several factors might influence PCPs’ access to in-house diagnostic ultrasonography, and future research should focus on exploring these factors further. We would like to thank Associate Professor, PhD Torben Tvedebrink for statistical assistance, the Örenäs Research Group collaborators who collected the survey data and all the PCPs who completed the survey. Contributors CAA, MH, BST, PV and MBBJ all participated in designing the study. CAA performed the analysis and wrote the first draft of the article in collaboration with MH and MBBJ. All authors participated in the review process and made significant contributions to the final version of the article. The following Örenäs Research Group members participated in designing and/or piloting the study, and are non-author collaborators: Isabelle Aubin-Auger, Université Paris Diderot, France; Joseph Azuri, Tel Aviv University, Israel; Matte Brekke, University of Oslo, Norway; Krzysztof Buczkowski, Nicolaus Copernicus University, Poland; Nicola Buono, National Society of Medical Education in General Practice (SNaMID), Italy; Emiliana Costiug, Iuliu Hatieganu University of Medicine and Pharmacy, Romania; Geert-Jan Dinant, Maastricht University, Netherlands; Magdalena Esteva, Majorca Primary Health Care Department, Palma Mallorca, Spain; Gergana Foreva, Medical Center BROD, Bulgaria; Svjetlana Gašparović Babić, The Teaching Institute of Public Health of Primorsko-goranska County, Croatia; Robert Hoffman, Tel Aviv University, Israel; Eva Jakob, Centro de Saúde Sarria, Spain; Tuomas Koskela, University of Tampere, Finland; Mercè Marzo-Castillejo, Institut Català de la Salut, Barcelona, Spain; Peter Murchie, University of Aberdeen, Scotland; Ana Luísa Neves, Imperial College, UK and University of Porto, Portugal; Davorina Petek and Marija Petek Ster, University of Ljubljana, Slovenia; Jolanta Sawicka-Powierza, Medical University of Bialystok, Poland; Antonius Schneider, Technische Universität München, Germany; Emmanouil Smyrnakis, Aristotle University of Thessaloniki, Greece; Sven Streit, University of Bern, Switzerland; Hans Thulesius, Lund University, Sweden; Birgitta Weltermann, University of Bonn, Germany. Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Competing interests None declared. Patient consent for publication Not required. Ethics approval Ethical approval for the original study was given by the University of Bath Research Ethics Approval Committee for Health (approval date: 24 Nov 2014; REACH reference no. EP 14/15 66). Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement Data are available on reasonable request.
Keywords
- diagnostic radiology
- organisation of health services
- primary care
- ultrasound
ASJC Scopus subject areas
- General Medicine