Swipe om te navigeren naar een ander artikel
Open access echocardiography has been evaluated in the United Kingdom, but hardly in the Netherlands. The echocardiography service of the SHL-Groep in Etten-Leur was set up independently from the regional hospitals. Cardiologists not involved in the direct care of the participating patients evaluated the echocardiograms taken by ultrasound technicians.
We estimated the reduction in the number of referrals to regional cardiologists, the adherence of the general practitioners (GPs) to the advice of the evaluating cardiologist, GPs’ opinion on the benefit of the echocardiography service and GPs’ adherence to the diagnostic protocol advocated in the Dutch clinical guideline for heart failure.
A prospective cohort study was performed. Patients were included from April 2011 to April 2012 (N = 155). Data from application forms (N = 155), echocardiography results (N = 155) and telephone interviews with GPs (N = 138) were analysed.
GPs referred less patients to the cardiologist than they would have done without echocardiography available (92 % vs. 34 %, p < 0.001). They treated more patients by themselves (62 % vs. 10 %, p < 0.001). Most GPs (81 %) followed the advice presented on the echocardiogram result. Most GPs (82 %) found the service had clinical benefit for the patient. Sixty two percent of echocardiography requests met the criteria of the Dutch clinical guideline for heart failure.
Open access echocardiography saved referrals to the cardiology department, saved time, and enabled GPs to treat more patients by themselves. Adherence to diagnostic guidelines for heart failure was suboptimal.
Hoes A, Voors A, Rutten F, et al. NHG-Standaard Hartfalen (Tweede herziening). Huisarts Wet. 2010;53(7):368–89.
Baur L, Veenstra L, Lenderink T, et al. Open access echocardiography is feasible in the Netherlands. Neth Heart J. 2006;14(11):361–5.
Kluiver EP. Effecten van vrije toegang van de huisarts tot niet-invasief cardiaal functie-onderzoek: een nieuwe selectiemethode als alternatief voor directe verwijzing naar de cardiologische polikliniek. Rotterdam: Erasmus University Rotterdam; 2003.
Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18(12):1440–63. PubMedCrossRef
Sim V. Review finds inadequate evidence of the cost effectiveness and efficacy of open access echocardiography in primary care. Evid Based Cardiovasc Med. 2004;8(2):180–2. CrossRef
Williams S, Currie P, Silas J. Open access echocardiography: a prospective audit of referral patterns from primary care. Int J Clin Pract. 2003;57(2):136–9. PubMed
Horne R, Coombes I, Davies G, et al. Barriers to optimum management of heart failure by general practitioners. Br J Gen Pract. 1999;49(442):353. PubMed
- Benefits of an open access echocardiography service: a Dutch prospective cohort study
N. van Gurp
L. J. M. Boonman-De Winter
D. W. Meijer Timmerman Thijssen
H. E. J. H. Stoffers
- Bohn Stafleu van Loghum