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BMC Health Services Research

, 10:37

First Online: 10 February 2010Received: 22 April 2009Accepted: 10 February 2010DOI: 10.1186-1472-6963-10-37

Cite this article as: van Heur, L.M., Baur, L.H., Tent, M. et al. BMC Health Serv Res 2010 10: 37. doi:10.1186-1472-6963-10-37

Abstract

BackgroundIn our region Eastern South Limburg, The Netherlands an open access echocardiography service started in 2002. It was the first service of this kind in The Netherlands. Our study aims were: 1 to evaluate demand for the service, participation, indications, echocardiography outcomes, and management by the general practitioner GP; 2 to analyse changes in indications and outcomes over the years.

Methods1 Data from GP request forms, echocardiography reports and a retrospective GP questionnaire on management response rate 83% of 625 consecutive patients Dec. 2002 - March 2007 were analysed cross-sectionally. 2 For the analysis of changes over the years, data from GP request forms and echocardiography reports of the first and last 250 patients that visited the service between Dec. 2002 and Feb. 2008 n = 1001 were compared.

ResultsThe echocardiography service was used by 81% of the regional GPs. On average, a GP referred one patient per year to the service. Intended indications for the service were dyspnoea 32%, cardiac murmur 59%, and peripheral oedema 17%. Of the other indications 22%, one-third was for evaluation of suspected left ventricular hypertrophy LVH. Expected outcomes were left ventricular dysfunction LVD 43%, predominantly diastolic and valve disease 25%. We also found a high proportion of LVH 50%. Only 24% of all echocardiograms showed no relevant disease. The GP followed the cardiologist-s advice to refer the patient for further evaluation in 71%. In recent patients, more echocardiography requests were done for -cardiac murmur- and -other- indications, but less for -dyspnoea-. The proportions of patients with LVD, LVH and valve disease decreased and the proportion of patients with no relevant disease increased. The number of advices by the cardiologists increased.

ConclusionOverall, GPs used the open access echocardiography service efficiently i.e. with a high chance of finding relevant pathology, but efficiency decreased slightly over the years. To meet the needs of the GPs, indications might be widened with -suspicion LVH-. Further specification of the indications for open access echocardiography - by defining a stepwise diagnostic approach including ECG and NT-proBNP - might improve the service.

Electronic supplementary materialThe online version of this article doi:10.1186-1472-6963-10-37 contains supplementary material, which is available to authorized users.

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Autor: Leanne MSG van Heur - Leo HB Baur - Marleen Tent - Cara LB Lodewijks-van der Bolt - Marjolijn Streppel - Ron AG Winkens

Fuente: https://link.springer.com/







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