Peter Vedsted

Direct-access to sonographic diagnosis of deep vein thrombosis in general practice: a descriptive cohort study

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

Standard

Direct-access to sonographic diagnosis of deep vein thrombosis in general practice : a descriptive cohort study. / Appel, Charlotte W.; Balle, Annette M.; Krintel, Mads M.; Vittrup, Axel; Nielsen, Agnete H.; Vedsted, Peter.

I: BMC Family Practice, Bind 21, 195, 09.2020.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

Harvard

APA

CBE

MLA

Vancouver

Author

Appel, Charlotte W. ; Balle, Annette M. ; Krintel, Mads M. ; Vittrup, Axel ; Nielsen, Agnete H. ; Vedsted, Peter. / Direct-access to sonographic diagnosis of deep vein thrombosis in general practice : a descriptive cohort study. I: BMC Family Practice. 2020 ; Bind 21.

Bibtex

@article{d5c98754fbdc4df5a722d8a50907916d,
title = "Direct-access to sonographic diagnosis of deep vein thrombosis in general practice: a descriptive cohort study",
abstract = "BACKGROUND: Suspicion of deep vein thrombosis (DVT) is common and requires urgent and efficient investigation due to hazardous prognosis. The traditional diagnostic pathway can be complex and time-consuming, and innovative solutions may provide easy access to diagnostics and better use of healthcare resources. We aimed to describe use, clinical outcomes and time used when providing general practitioners (GPs) with a direct-access pathway to hospital-based, single whole-leg compression ultrasound (CUS) for patients with suspected DVT. Furthermore we aimed to describe the resources used in the new direct-access pathway and compare it with the previous pathway. METHODS: We conducted a 2-year descriptive cohort study (2016-2017) including 449 consecutively referred patients for diagnosis of DVT in a Danish regional hospital. The previous pathway included pre-test at the medical department, a proximal leg CUS if required based on the pre-test and a re-scan if the first CUS was negative. The new pathway included two strategies: 1) a 'yes-no strategy', where GPs referred patients directly to whole-leg CUS and if positive, treated at the medical department and if negative, discharged to the GP, 2) a 'follow-up strategy' where GPs could require that patients were seen at the medical department, irrespective of the CUS result. Data included extractions from the Radiology Information and Patient Administrative Systems, and mean salaries of healthcare professionals at Silkeborg Regional Hospital, Denmark. Descriptive statistics were used to describe prevalence, timelines and costs. RESULTS: GPs referred 318 (71%) patients through the yes-no strategy and 131 (29%) via the follow-up strategy with DVT diagnosed in 48 (15%) and 51 (39%) patients, respectively (p < 0.001). For the 263 patients completed after CUS in the yes-no strategy, median pathway time was 24 min (IQI: 16-36), and for those with DVT (including both strategies) 202 min (IQI: 158-273). Direct-access pathway costs were €49.7 less per patient than the previous pathway. CONCLUSION: Direct-access to CUS for suspected DVT was achievable, had short time intervals and required fewer resources. The difference in DVT prevalence indicates that GPs distinguish between patients with low and high risk of DVT.",
keywords = "Clinical decision-making, Denmark, Diagnosis, General practice, Ultrasonography, Venous thrombosis",
author = "Appel, {Charlotte W.} and Balle, {Annette M.} and Krintel, {Mads M.} and Axel Vittrup and Nielsen, {Agnete H.} and Peter Vedsted",
year = "2020",
month = sep,
doi = "10.1186/s12875-020-01267-x",
language = "English",
volume = "21",
journal = "B M C Family Practice",
issn = "1471-2296",
publisher = "BioMed Central Ltd.",

}

RIS

TY - JOUR

T1 - Direct-access to sonographic diagnosis of deep vein thrombosis in general practice

T2 - a descriptive cohort study

AU - Appel, Charlotte W.

AU - Balle, Annette M.

AU - Krintel, Mads M.

AU - Vittrup, Axel

AU - Nielsen, Agnete H.

AU - Vedsted, Peter

PY - 2020/9

Y1 - 2020/9

N2 - BACKGROUND: Suspicion of deep vein thrombosis (DVT) is common and requires urgent and efficient investigation due to hazardous prognosis. The traditional diagnostic pathway can be complex and time-consuming, and innovative solutions may provide easy access to diagnostics and better use of healthcare resources. We aimed to describe use, clinical outcomes and time used when providing general practitioners (GPs) with a direct-access pathway to hospital-based, single whole-leg compression ultrasound (CUS) for patients with suspected DVT. Furthermore we aimed to describe the resources used in the new direct-access pathway and compare it with the previous pathway. METHODS: We conducted a 2-year descriptive cohort study (2016-2017) including 449 consecutively referred patients for diagnosis of DVT in a Danish regional hospital. The previous pathway included pre-test at the medical department, a proximal leg CUS if required based on the pre-test and a re-scan if the first CUS was negative. The new pathway included two strategies: 1) a 'yes-no strategy', where GPs referred patients directly to whole-leg CUS and if positive, treated at the medical department and if negative, discharged to the GP, 2) a 'follow-up strategy' where GPs could require that patients were seen at the medical department, irrespective of the CUS result. Data included extractions from the Radiology Information and Patient Administrative Systems, and mean salaries of healthcare professionals at Silkeborg Regional Hospital, Denmark. Descriptive statistics were used to describe prevalence, timelines and costs. RESULTS: GPs referred 318 (71%) patients through the yes-no strategy and 131 (29%) via the follow-up strategy with DVT diagnosed in 48 (15%) and 51 (39%) patients, respectively (p < 0.001). For the 263 patients completed after CUS in the yes-no strategy, median pathway time was 24 min (IQI: 16-36), and for those with DVT (including both strategies) 202 min (IQI: 158-273). Direct-access pathway costs were €49.7 less per patient than the previous pathway. CONCLUSION: Direct-access to CUS for suspected DVT was achievable, had short time intervals and required fewer resources. The difference in DVT prevalence indicates that GPs distinguish between patients with low and high risk of DVT.

AB - BACKGROUND: Suspicion of deep vein thrombosis (DVT) is common and requires urgent and efficient investigation due to hazardous prognosis. The traditional diagnostic pathway can be complex and time-consuming, and innovative solutions may provide easy access to diagnostics and better use of healthcare resources. We aimed to describe use, clinical outcomes and time used when providing general practitioners (GPs) with a direct-access pathway to hospital-based, single whole-leg compression ultrasound (CUS) for patients with suspected DVT. Furthermore we aimed to describe the resources used in the new direct-access pathway and compare it with the previous pathway. METHODS: We conducted a 2-year descriptive cohort study (2016-2017) including 449 consecutively referred patients for diagnosis of DVT in a Danish regional hospital. The previous pathway included pre-test at the medical department, a proximal leg CUS if required based on the pre-test and a re-scan if the first CUS was negative. The new pathway included two strategies: 1) a 'yes-no strategy', where GPs referred patients directly to whole-leg CUS and if positive, treated at the medical department and if negative, discharged to the GP, 2) a 'follow-up strategy' where GPs could require that patients were seen at the medical department, irrespective of the CUS result. Data included extractions from the Radiology Information and Patient Administrative Systems, and mean salaries of healthcare professionals at Silkeborg Regional Hospital, Denmark. Descriptive statistics were used to describe prevalence, timelines and costs. RESULTS: GPs referred 318 (71%) patients through the yes-no strategy and 131 (29%) via the follow-up strategy with DVT diagnosed in 48 (15%) and 51 (39%) patients, respectively (p < 0.001). For the 263 patients completed after CUS in the yes-no strategy, median pathway time was 24 min (IQI: 16-36), and for those with DVT (including both strategies) 202 min (IQI: 158-273). Direct-access pathway costs were €49.7 less per patient than the previous pathway. CONCLUSION: Direct-access to CUS for suspected DVT was achievable, had short time intervals and required fewer resources. The difference in DVT prevalence indicates that GPs distinguish between patients with low and high risk of DVT.

KW - Clinical decision-making

KW - Denmark

KW - Diagnosis

KW - General practice

KW - Ultrasonography

KW - Venous thrombosis

UR - http://www.scopus.com/inward/record.url?scp=85091470599&partnerID=8YFLogxK

U2 - 10.1186/s12875-020-01267-x

DO - 10.1186/s12875-020-01267-x

M3 - Journal article

C2 - 32957932

AN - SCOPUS:85091470599

VL - 21

JO - B M C Family Practice

JF - B M C Family Practice

SN - 1471-2296

M1 - 195

ER -