Original Title: Indicaciones, utilidad y uso de la ecografía en Atención Primaria

Authors' objectives: To assess the effectiveness, clinical utility and efficacy of ultrasonography in primary care, define the clinical situations in which it should be applied and the requirements for its use

Authors' results and conclusions: Ultrasonography is a proven technology with good diagnostic performance when used by professionals with the appropriate skills and in populations where the prevalence of certain health problems and risk factors exceed given thresholds. Several studies have concluded that the diagnostic skills, reliability and performance of primary care clinicians seems to improve significantly when they add information obtained in ultrasonography to their usual diagnostic arsenal, helping to confirm or rule out various types of lesions or disorders. The key studies and their findings can be summarised as follows: • A case series reported in the context of a theoretical and practical ultrasound training programme for doctors, with a subsequent assessment of student competencies in obtaining the correct plane and detecting diseases in real patients, led to the conclusion that ultrasonography is an educational tool in medical training and does help enhance the physical examination. • A prospective study with 114 patients with abdominal pain concluded that primary care doctors that perform low-to-moderate complexity ultrasound examinations had a very high level of interrater agreement compared to that of specialists. • A prospective non-randomised study comparing radiographic examinations performed successively and independently by primary care doctors and radiologists concluded that primary care doctors are able to perform low-complexity abdominal ultrasound scans with diagnostic competence. • A prospective multicentre cohort of 1107 patients suggested that compression ultrasonography carried out by trained primary care doctors may be a good option in cases of suspected proximal deep vein thrombosis. • A pilot cohort study based on 106 patients concluded that, with adequate training, portable ultrasonography may be a useful and effective technique for screening for aneurysm of the abdominal aorta. Its good level of acceptance among patients, portability, safety and high cost-effectiveness ratio mean that it may be considered an additional method for the assessment of cardiovascular risk. Regarding comparative costs, it was found that the cost of primary care ultrasonography depends to a great extent on the costs of training courses and of the ultrasound systems used, the number of ultrasound examinations performed by primary care physicians per year and the time they spend on these examinations. Although we have not found confirmatory evidence in the scientific literature, according to personal communication with radiologists and primary care clinicians who have adopted the use of ultrasonography, the acquisition of sufficient skills to carry out the least complex procedures and identify more complex cases that should be referred requires not only formal training, but also hands-on experience with an ultrasound device, supervised or not, to complete an individual learning curve. CONCLUSIONS The use of ultrasonography in routine primary care medical practice seems to be a trend that will enable health professionals to improve the care provided to their patients. The use of this type of imaging can immediately narrow the differential diagnosis based on the clinical information revealed by a traditional physical examination while refining clinical decision making for the subsequent management of the patient’s condition. The economic analysis conducted helps us to understand the direct medical costs associated with ultrasonography and the contributing components.

Authors' methods: A search was conducted of the scientific literature with no time limit in databases that list publications on primary or secondary care and applied research, such as MEDLINE, Embase, the Centre for Reviews and Dissemination databases (HTA, NHS EED, DARE), the Cochrane Library and the National Guidelines Clearinghouse, seeking to identify publications that analyse the technique of interest.

Project Status: Completed

Year Published: 2019

URL for published report: https://www.euskadi.eus/web01-a2aznscp/es/k75aWebPublicacionesWar/k75aObtenerPublicacionDigitalServlet?R01HNoPortal=true&N_LIBR=052412&N_EDIC=0001&C_IDIOM=es&FORMATO=.pdf

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Osteba (Basque Office for Health Technology Assessment) Health Department of the Basque Government</p>