Ultrasound scanning by general practitioners: is it worthwhile?
BACKGROUND: There are several alternatives for providing ultrasound scanning, besides traditional hospital-based services. One such alternative is for general practitioners (GPs) to perform scanning in the community. The aim of this study was to evaluate the impact of GP ultrasound scanning on the use of National Health Service (NHS) resources in the United Kingdom (UK), and elicit patients' preferences for having an ultrasound scan. METHODS: A cost analysis and an assessment of quality of GP scans, based on a clinical audit and a postal survey of patients' preferences, were carried out. The setting was a rural general practice and urban teaching hospital in the Grampian region of Scotland. The analysis of costs and assessment of the quality of GP scans were based on 131 patients scanned at the practice in a 6 month clinical audit period. The survey of patients' preferences was undertaken on a random sample of 500 patients from the GPs' list and 250 consecutive patients scanned at the practice. RESULTS: The assessment of the management of patients during audit revealed that the scanner at the practice reduced the number of hospital scans, number of out-patient and in-patient visits, and emergency admissions. The unit cost of a scan was higher in the practice than at the hospital. However, when all the costs for a scanning episode were considered, the total and average costs were lower in the practice because of the avoidance of hospital visits. The results showed that the quality of GP scanning, subject to further training, was considered to be sufficient to continue scanning at the practice. Patients preferred to be scanned at the practice, and were prepared to wait up to an extra 5 days, and accept a reduction in the accuracy of scanning of up to 3.5 per cent for their choice. Who carried out the scan was not important to patients. CONCLUSION: Although the results of the study provide some evidence to support GP scanning in this setting, further research on diagnostic accuracy and alternative models of care need to be conducted.