Adequacy and quality of abdominal echographies requested by primary care professionals

Abstract

BackgroundThe value of abdominal echography in primary care is great because it is innocuous, inexpensive, easy to perform and provides a great deal of information making this the first examination to be requested in cases of probable abdominal disease. However, too many abdominal echographies are probably requested overcrowding the Departments of Radiodiagnosis with not always justified petitions or with repetition of tests based on little clinical criteria.Methods/DesignThe aim of the study is to evaluate the adequacy and quality of abdominal echographies requested by primary care physicians in the Maresme County (North of Barcelona), develop guidelines for indicating echographies and reevaluate this adequacy after implementing these guidelines.We will perform a two-phase study: the first descriptive, and retrospective evaluating the adequacy and quality of petitions for abdominal echographies, and in the second phase we will evaluate the impact of recommendations for indicating abdominal echographies for PC physicians on the adequacy and quality of echography petitions thereafter.This study will be carried out in 10 primary care centres in the Maresme (Barcelona).1067 abdominal echographies requested by primary care physicians from the above mentioned centres from January 2007 to April 2010 and referred to the Department of Radiology and the same number of applications after the intervention.All the petitions for abdominal echographies requested will be analysed and the clinical histories will be obtained to determine demographic variables, the reason for the visit and for the echography petition and diagnostic orientation, clinical and echographic data, evaluation of the echographies according to the quality and variables characterising the professionals requesting the echographies including: age, sex, laboral situation, length of time in work post, formation, etc.To achieve a consensus of the adequacy of abdominal echography, a work group including gastroenterologists, radiologists and general practitioners will be created following the nominal group. This will allow the design of guidelines for the indication of abdominal echography and posterior evaluation of their impact among physicians by diffusion and posterior reevaluation of the adequacy of the petitions.

The justification of non-obstetric ultrasound referrals: A safe and effective practice

“…34 Referrals need to be regulated to ensure examinations are not repeated when unnecessary and should only be done when findings are expected to alter patient care. 10 Report quality is directly proportional to referral quality. 14 , 18 Therefore, the need for a proper and clear clinical question is required to ensure the examination is justified and to ensure the correct examination is being performed in order to answer the imposed clinical question.…”

“…This route also requires GPs to have the knowledge to be able to order the correct test. 32 This pressure is amplified by the fact that as many as 40% of referrals are unnecessary 2,10 and that onethird of referrals are 'consumed by the worried well'. 34 Referrals need to be regulated to ensure examinations are not repeated when unnecessary and should only be done when findings are expected to alter patient care.…”

“…Studies have found imaging services are overused by GPs, with up to 40% of investigations being unnecessary 2 , 10 The resultant increase in incidental findings generates further unrequired investigation. 11 Over imaging, repeat imaging, incorrect modality and unnecessary investigations all contribute to inappropriate use of imaging resources.…”

“…12 This results in financial and capacity burden thereby reducing imaging turn-around times. 2 , 10 , 13 , 14…”

“…12 This results in financial and capacity burden thereby reducing imaging turnaround times. 2,10,13,14 Evidence suggests referrals are often made without a true imposed clinical question. 12 Referrers have a responsibility to provide adequate information for practitioners to make informed decisions about pathological findings.…”