Primary care physicians' access to in-house ultrasound examinations across Europe: a questionnaire study
Camilla Aakjær Andersen1, Martin Bach B Jensen2, Berit Skjødeberg Toftegaard3,4
1Center for General Practice, Aalborg University, Aalborg, Denmark caakjaer@dcm.aau.dk.
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.
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