Primary care physicians' access to in-house ultrasound examinations across Europe: a questionnaire study

Camilla Aakjaer Andersen*, Martin Bach B. Jensen, Berit Skjodeberg Toftegaard, Peter Vedsted, Michael Harris, Isabelle Aubin-Auger, Joseph Azuri, Matte Brekke, Krzysztof Buczkowski, Nicola Buono, Emiliana Costiug, Geert-Jan Dinant, Magdalena Esteva, Gergana Foreva, Svjetlana Gasparovic Babic, Robert Hoffman, Eva Jakob, Tuomas Koskela, Merce Marzo-Castillejo, Peter MurchieAna Luisa Neves, Davorina Petek, Marija Petek Ster, Jolanta Sawicka-Powierza, Antonius Schneider, Emmanouil Smyrnakis, Sven Streit, Hans Thulesius, Birgitta Weltermann, Örenäs Research group

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Objective The overall objective of this study was to examine the differences in ultrasound availability in primary care across Europe.

Design Cross-sectional study.

Setting Primary care.

Participants Primary care physicians (PCPs).

Primary and secondary outcomes measures The primary aim was to describe the variation in in-house primary care ultrasonography availability across Europe using descriptive statistics. The secondary aim was to explore associations between in-house ultrasonography availability and the characteristics of PCPs and their clinics using a mixed-effects logistic regression model.

Results We collected data from 20 European countries. A total of 2086 PCPs participated, varying from 59 to 446 PCPs per country. The median response rate per country was 24.8%. The median (minimum-maximum) percentage of PCPs across Europe with access to in-house abdominal ultrasonography was 15.3% (0.0%-98.1%) and 12.1% (0.0%-30.8%) had access to in-house pelvic ultrasonography with large variations between countries. We found associations between in-house abdominal ultrasonography availability and larger clinics (OR 2.5, 95% CI 1.2 to 4.9) and clinics with medical doctors specialised in areas, which traditionally use ultrasonography (OR 2.1, 95% CI 1.1 to 3.8). Corresponding associations were found between in-house pelvic ultrasonography availability and larger clinics (OR 1.9, 95% CI 1.3 to 2.7) and clinics with medical doctors specialised in areas, which traditionally use ultrasonography (OR 3.0, 95% CI 1.8 to 5.1). Additionally, we found a negative association between urban clinics and in-house pelvic ultrasound availability (OR 0.5, 95% CI 0.2 to 0.9).

Conclusions Across Europe, there is a large variation in PCPs' access to in-house ultrasonography and organisational aspects of primary care seem to determine this variation. If evidence continues to support ultrasonography as a front-line point-of-care test, implementation strategies for increasing its availability in primary care are needed. Future research should focus on facilitators and barriers that may affect the implementation process.

Original languageEnglish
Article number030958
Number of pages8
JournalBMJ Open
Issue number9
Publication statusPublished - Sept 2019


  • organisation of health services
  • primary care
  • diagnostic radiology
  • ultrasound

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