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Zumstein N, Merlo C, Essig S, Auer R, Tal K, Hari R. The use of diagnostic ultrasound by primary care physicians in Switzerland - a cross-sectional study. BMC PRIMARY CARE 2024; 25:246. [PMID: 38971759 PMCID: PMC11227144 DOI: 10.1186/s12875-024-02491-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/26/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Diagnostic ultrasound has become a bedside tool widely available to many primary care physicians (PCPs) in Europe. It is often used as point-of-care ultrasonography (POCUS) in this setting. In Switzerland, certain POCUS examinations are listed as learning objectives in existing ultrasound training programs (we defined these examinations as swissPOCUS = sPOCUS). Ultrasound performed by PCPs can lead to faster diagnostic workup and reduce referral to secondary care units. However, adequate training is crucial to guarantee high quality. To guide the development of ultrasound training programs for PCPs, this study explores the use of ultrasound in primary care in Switzerland. METHODS This was a cross-sectional study. We invited PCPs from the Swiss practice-based research network "Sentinella" to collect data on the first 5 daily ultrasounds they ordered or performed themselves. Participating PCPs collected data for 3 months - divided into 4 groups to account for seasonal differences. RESULTS Out of 188 PCPs invited, 81.9% provided data through an initial questionnaire. 46.8% provided data on 1616 ultrasounds. 56.5% of PCPs had access to ultrasound machines, while 29.8% had completed formal training. 77% of the reported ultrasounds were self-performed; 27% of the reported scans (35% of all self-performed scans) were performed by PCPs with incomplete or no formal training. The main areas of interest were the abdominal (57.9%) and the musculoskeletal (22%) region. 36.9% of reported examinations were sPOCUS exams. Among PCPs with access to US machines, the percentages of referred examinations were similar for sPOCUS (11.9%) and non-sPOCUS (11.3%) indications. However, some sPOCUS musculoskeletal ultrasounds were often referred (e.g. tendon/ligament/muscle injuries or cutaneous/subcutaneous tumour). CONCLUSION Most Swiss PCPs had access to ultrasound equipment and performed a majority of both sPOCUS and non-sPOCUS scans themselves, often without or with incomplete training. This reflects the fact that POCUS was only recently introduced in Switzerland. There is a need for easily accessible POCUS training programs aimed at PCPs in Switzerland. Training courses for PCPs should focus on abdominal and musculoskeletal ultrasound, because these were the most common sites for scans, and because some sPOCUS musculoskeletal examinations showed a particularly high percentage of referral.
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Affiliation(s)
- Nico Zumstein
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
| | - Christoph Merlo
- Center for Primary and Community Care, University of Lucerne, Lucerne, Switzerland
- Swiss Sentinel Surveillance Network, Federal Office of Public Health, Bern, Switzerland
| | - Stefan Essig
- Center for Primary and Community Care, University of Lucerne, Lucerne, Switzerland
| | - Reto Auer
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- Swiss Sentinel Surveillance Network, Federal Office of Public Health, Bern, Switzerland
| | - Kali Tal
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Roman Hari
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Dean's Office, Medical Faculty, University of Bern, Bern, Switzerland
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De Silva L, Baysari M, Keep M, Kench P, Clarke J. Patient initiated radiology requests: proof of wellness through images. Aust J Prim Health 2023; 29:670-678. [PMID: 37614071 DOI: 10.1071/py22247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 07/24/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Traditionally, general practitioners (GPs) have initiated the need for, and ordered, radiological tests. With the emergence of consumer-centred care, patients have started to request scans from doctors on their own initiative. Consumeristic health care has shifted the patient-doctor dyadic relationship, with GPs trending towards accommodating patients' requests. METHODS A mixed method analysis was conducted using a survey instrument with open ended questions and concurrent interviews to explore participants' responses from their requests for radiological studies from GPs. Themes emerging from both qualitative and quantitative methodologies were mapped onto the Andersen Newman Model (ANM). RESULTS Data were analysed for 'predisposing,' 'need' and 'enabling' elements of the ANM model and were correspondingly mapped to patient's requests for radiological referrals according to the elements of the ANM. Participants expressed anxiety about their health, were confident in the types of radiological scans they desired and typically indicated the need for evidence of good health. Their desire for such requested scans was often enabled through prior exposure to health information and the experience of specific symptoms. Requests came with the expectation of validation, and if these requests were denied, participants indicated that they would seek another doctor who would oblige. CONCLUSIONS In our modest study of Australian patients, participants were well informed about their health. Exposure to information seems to create a sense of anxiousness prior to visiting the doctor. Individuals sought visual proof of wellness through imaging, and doctors in return often accommodated patient requests for radiological studies to appease patients' needs and to maintain workflow.
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Affiliation(s)
- Lizzie De Silva
- Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Camperdown Campus, Western Avenue, Camperdown, NSW 2006, Australia
| | - Melissa Baysari
- Biomedical Informatics and Digital Health, Faculty of Medicine and Health, Charles Perkins Centre D17, The University of Sydney, Sydney, NSW 2006, Australia
| | - Melanie Keep
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building D18, Camperdown, NSW 2006, Australia
| | - Peter Kench
- Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Camperdown Campus, Western Avenue, Camperdown, NSW 2006, Australia
| | - Jillian Clarke
- Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Camperdown Campus, Western Avenue, Camperdown, NSW 2006, Australia
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Gaget V, Inacio MC, Tivey DR, Jorissen RN, Babidge WJ, Visvanathan R, Maddern GJ. Trends in utilisation of ultrasound by older Australians (2010-2019). BMC Geriatr 2023; 23:50. [PMID: 36707769 PMCID: PMC9883967 DOI: 10.1186/s12877-023-03771-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/23/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Older people have increasingly complex healthcare needs, often requiring appropriate access to diagnostic imaging, an essential component of their health and disease management planning. Ultrasound is a safe imaging tool used to diagnose several conditions commonly experienced by older people such as deep vein thrombosis. PURPOSE To evaluate the utilisation of major ultrasound services by Australians ≥ 65 years old between 2009- and 2019. METHODS This population-based and yearly cross-sectional study of ultrasound utilisation per 1,000 Australians ≥ 65 years old was conducted using publicly available data sources. Overall, examination site and age- and sex-specific incidence rate (IR) of ultrasound per 1,000 people, adjusted incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were calculated using negative binomial regression models. RESULTS Over the study period, the crude utilisation of ultrasound increased by 83% in older Australians. Most ultrasound examinations were conducted on extremities (39%) and the chest (21%), with 25% of all ultrasounds investigating the vascular system. More men than women use ultrasounds of the chest (184/1,000 vs 268/1,000 people), particularly echocardiograms (177/1,000 vs 261/1,000 people), and abdomen (88/1,000 vs 92/1,000 people), especially in those ≥ 85 years old. Hip and pelvic ultrasound were used more by women than men (212/1,000 vs 182/1,000 people). There were increases in vascular abdominal (IRR:1.07, 95%CI:1.06-1.08) and extremeties (IRR:1.06, 95%CI:1.05-1.07) ultrasounds over the study period, particularly in ≥ 75 years old men. CONCLUSIONS Ultrasound is a common and increasingly used diagnostic tool for conditions commonly experienced by older Australians.
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Affiliation(s)
- Virginie Gaget
- grid.1010.00000 0004 1936 7304Surgical Specialities, University of Adelaide, The Queen Elizabeth Hospital, Woodville, South Australia 5011 Australia
| | - Maria C. Inacio
- grid.430453.50000 0004 0565 2606Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA 5001 Australia ,grid.1026.50000 0000 8994 5086UniSA Allied Health and Human Movement, University of South Australia, Adelaide, Australia
| | - David R. Tivey
- grid.1010.00000 0004 1936 7304Surgical Specialities, University of Adelaide, The Queen Elizabeth Hospital, Woodville, South Australia 5011 Australia ,grid.419296.10000 0004 0637 6498Royal Australasian College of Surgeons, Adelaide, SA 5001 Australia
| | - Robert N. Jorissen
- grid.430453.50000 0004 0565 2606Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA 5001 Australia
| | - Wendy J. Babidge
- grid.1010.00000 0004 1936 7304Surgical Specialities, University of Adelaide, The Queen Elizabeth Hospital, Woodville, South Australia 5011 Australia ,grid.419296.10000 0004 0637 6498Royal Australasian College of Surgeons, Adelaide, SA 5001 Australia
| | - Renuka Visvanathan
- grid.1010.00000 0004 1936 7304Adelaide Geriatrics Training and Research With Aged Care Centre (GTRAC), Faculty of Health and Medical Sciences, University of Adelaide, Woodville, SA 5011 Australia ,Aged & Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Woodville, SA 5011 Australia
| | - Guy J. Maddern
- grid.1010.00000 0004 1936 7304Surgical Specialities, University of Adelaide, The Queen Elizabeth Hospital, Woodville, South Australia 5011 Australia ,grid.419296.10000 0004 0637 6498Royal Australasian College of Surgeons, Adelaide, SA 5001 Australia
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AlSaif HI, Alzaid AS, Albabtain MA, Alharbi AA, Alnahabi FK, Alarifi AI, Alqasoumi MS, Alhawas AY, Alsaad SM. The Diagnostic Yield of Abdominal Ultrasounds Requested by Family Physicians at an Academic Hospital in Riyadh, Saudi Arabia. Cureus 2022; 14:e25580. [PMID: 35800194 PMCID: PMC9252938 DOI: 10.7759/cureus.25580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2022] [Indexed: 11/09/2022] Open
Abstract
Background: Abdominal ultrasound is a non-invasive, relatively inexpensive, and widely available diagnostic modality in family medicine settings. Objectives: Our study aimed to identify the most common indications for requesting abdominal ultrasounds by family physicians, determine the frequency of abdominal ultrasound with abnormal findings, identify the most common findings, and determine patients’ characteristics associated with abnormal findings. Methods: This retrospective chart-based study was conducted from January 2020 to June 2020 to analyze patients’ abdominal ultrasounds reports requested by family physicians in 2019 at King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia. Results: We assessed abdominal ultrasound reports of 1,113 patients. There were 620 (55.7%) female patients. The mean age and body mass index (BMI) were 46.35 years ± 15.04 and 29.33 kg/m2 ± 7.06, respectively. The most common indications were abdominal pain (43.2%), suspicion of gallbladder and biliary system diseases (18.5%), and abnormal liver function tests (14.6%). The frequency of abnormal findings was 793 (71.2%), and the most common findings were fatty liver infiltration (49.7%), liver enlargement (20.1%), and gallstones (13.3%). Females had a lower likelihood to have abnormal findings compared to males (odds ratio (OR)=0.688, p=0.009). Lastly, the likelihood of abnormal findings increased with age and was highest among patients aged 71 years or more (OR=25.9, p< 0.001). Conclusion: Abnormal findings were more prevalent in our study compared with other studies. Abnormal findings were more common among males and older age groups. We recommend future studies on patients from community-based family medicine settings, and to examine the association of abnormal findings with patient-centered endpoints. Finally, disseminating the results of this study will inform family physicians with the most common abnormal abdominal ultrasound findings, and will enhance the discussion with patients undergoing an abdominal ultrasound examination.
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Wong KY, Lau MW, Lee MH, Chan CH, Mak SH, Ng CF, Ying MTC. Study on the effects of arm abduction angle and cushion support during sonographic examination on the stiffness of supraspinatus muscle of sonographers using shear wave elastography. J Occup Health 2021; 63:e12306. [PMID: 34889491 PMCID: PMC8662659 DOI: 10.1002/1348-9585.12306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/11/2021] [Accepted: 11/29/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The incidence of work-related musculoskeletal disorder remains high in sonography. The aims of this study are to determine the changes in muscle stiffness with different arm abduction angles, and to investigate the effect of cushion support on reducing muscle load in the supraspinatus when sonographers scan with the arm abducted to different angles. METHODS This is a prospective crossover study. Twenty-three healthy female subjects aged between 20 and 23 years were included. Subjects were instructed to simulate performing standardized abdominal ultrasound scans. The changes in muscle stiffness of supraspinatus, measured as shear modulus, at rest and at 30°, 45°, and 60° arm abduction angles with and without cushion support were evaluated using shear-wave elastography. Styrofoam support was used for the cushion support. RESULTS Mean shear moduli of supraspinatus were 27.77 ± 5.84 kPa at rest and 41.63 ± 7.09 kPa, 63.88 ± 14.43 kPa, and 89.76 ± 16.55 kPa for 30°, 45°, and 60° arm abduction respectively, which corresponds to 53%, 116% increase in muscle stiffness when scanning arm abducted from 30° to 45° and 60° (p < .001). After applying cushion support, shear moduli dropped to 24.04 ± 5.60 kPa, 31.98 ± 6.06 kPa, 37.47 ± 5.61 kPa for arm abducted to 30°, 45°, and 60° respectively (p < .001). The muscle stiffnesses between 30° abduction without support and 60° abduction with support had no significant difference (p > .05). CONCLUSIONS Muscle stiffness of supraspinatus increased with increasing arm abduction angle during ultrasound scanning. Utilizing cushion support underneath the arm was effective in reducing muscle stiffness in supraspinatus. Our results provide scientific justification on postural modifications for sonographers.
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Affiliation(s)
- Ka Y. Wong
- Department of Health Technology and InformaticsThe Hong Kong Polytechnic UniversityHong KongHong Kong
| | - Man W. Lau
- Department of Health Technology and InformaticsThe Hong Kong Polytechnic UniversityHong KongHong Kong
| | - Man H. Lee
- Department of Health Technology and InformaticsThe Hong Kong Polytechnic UniversityHong KongHong Kong
| | - Chi H. Chan
- Department of Health Technology and InformaticsThe Hong Kong Polytechnic UniversityHong KongHong Kong
| | - Siu H. Mak
- Department of Health Technology and InformaticsThe Hong Kong Polytechnic UniversityHong KongHong Kong
| | - Cheuk F. Ng
- Department of Health Technology and InformaticsThe Hong Kong Polytechnic UniversityHong KongHong Kong
| | - Michael T. C. Ying
- Department of Health Technology and InformaticsThe Hong Kong Polytechnic UniversityHong KongHong Kong
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Touhami D, Merlo C, Hohmann J, Essig S. The use of ultrasound in primary care: longitudinal billing and cross-sectional survey study in Switzerland. BMC FAMILY PRACTICE 2020; 21:127. [PMID: 32611390 PMCID: PMC7330951 DOI: 10.1186/s12875-020-01209-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/24/2020] [Indexed: 12/29/2022]
Abstract
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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Affiliation(s)
- Dima Touhami
- Department of Health Sciences and Medicine, University of Lucerne, 6002, Lucerne, Switzerland. .,Instiute of Primary and Community Care, 6004, Lucerne, Switzerland. .,Swiss Paraplegic Research, 6207, Nottwil, Switzerland.
| | - Christoph Merlo
- Instiute of Primary and Community Care, 6004, Lucerne, Switzerland
| | - Joachim Hohmann
- Medical Faculty, University of Basel, 4056, Basel, Switzerland.,Institute of Radiology and Nuclear Medicine, Cantonal Hospital Winterthur, 8400, Winterthur, Switzerland.,Swiss Society of Ultrasound in Medicine, 5000, Aarau, Switzerland
| | - Stefan Essig
- Instiute of Primary and Community Care, 6004, Lucerne, Switzerland
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Jandrić-Kočić M. Patient with tyroid nodules in the family medicine. PRAXIS MEDICA 2019. [DOI: 10.5937/pramed1904029j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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