荷兰开放获取超声心动图服务评估：一项关于适应证、结果、患者管理和趋势的混合方法研究。
Evaluation of an open access echocardiography service in the Netherlands: a mixed methods study of indications, outcomes, patient management and trends.
机构信息
Maastricht University Medical Centre, CAPHRI School for Public Health and Primary Care, Department of General Practice, PO Box 616, 6200MD, Maastricht, The Netherlands.
出版信息
BMC Health Serv Res. 2010 Feb 10;10:37. doi: 10.1186/1472-6963-10-37.
BACKGROUND
In 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.
METHODS
(1) 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.
RESULTS
The 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.
CONCLUSION
Overall, 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-pro)BNP--might improve the service.
背景
在我们所在地区（荷兰东南林堡），2002 年开始提供开放式超声心动图服务。这是荷兰首个此类服务。我们的研究目的是：（1）评估服务需求、参与度、适应证、超声心动图结果以及全科医生（GP）的管理；（2）分析多年来适应证和结果的变化。
方法
（1）分析 2002 年 12 月至 2007 年 3 月期间 625 例连续患者的 GP 申请单、超声心动图报告以及 GP 管理的回顾性调查问卷（应答率 83%）的数据。（2）为了分析多年来的变化，比较了 2002 年 12 月至 2008 年 2 月期间服务的前 250 名和最后 250 名 GP 申请单和超声心动图报告的数据（n=1001）。
结果
该超声心动图服务被区域内 81%的 GP 使用。GP 平均每年向该服务转诊一位患者。服务的预期适应证为呼吸困难（32%）、心杂音（59%）和外周水肿（17%）。其他适应证（22%）中，三分之一是评估疑似左心室肥厚（LVH）。预期结果是左心室功能障碍（LVD）（43%，主要为舒张功能障碍）和瓣膜疾病（25%）。我们还发现 LVH 比例较高（50%）。所有超声心动图中只有 24%未发现相关疾病。GP 遵循心脏病专家的建议，将患者转介进一步评估的比例为 71%。在最近的患者中，“心杂音”和“其他”适应证的超声心动图请求有所增加，但呼吸困难的请求减少。LVD、LVH 和瓣膜疾病患者的比例下降，无相关疾病患者的比例增加。心脏病专家的建议数量增加。
结论
总体而言，GP 有效地利用了开放式超声心动图服务（即发现相关病理学的可能性较高），但随着时间的推移效率略有下降。为了满足 GP 的需求，可以通过“疑似 LVH”扩大适应证。进一步明确开放式超声心动图的适应证——通过定义包括心电图和（NT-pro）BNP 的逐步诊断方法——可能会改善该服务。
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