Patient satisfaction with a teleradiology service in general practice.

BACKGROUND: Accessibility to secondary health services is not always easy for patients who live at a great distance of hospital. In these circumstances, transferring diagnostic tools and treatment options to primary care could prove beneficial for patients. To do so, the quality of medical care and the costs and benefits of the approach need to be assessed. However, the patient perspective is equally important, offering important insights. METHODS: In a cross-sectional study we investigate the satisfaction of patients toward a new teleradiology facility offered a general practice on Ameland, an island in the Netherlands. A questionnaire was created based on the Dutch version of the Patient Satisfaction Questionnaire III and completed by all patients after receiving an x-ray in primary care between June 1, 2007 and June 1, 2009. Those who received more than one x-ray in that period were included only once. The technical and interpersonal skills of doctors were rated out the sum score of the questionnaire namely 25 and 30, respectively. Analysis of variance (ANOVA) was used to analyze the differences between the means of the satisfaction subscales and the patient characteristics. RESULTS: The response proportion was after reminder 65% (381/587 patients). Satisfaction with the technical skills of the doctor providing the teleradiology service was 22.4 ± 3.7, while satisfaction with the interpersonal skills of the doctor during the diagnostic phase was 26.8 ± 3.8. Island residents, the elderly, and those with no history of trauma were more satisfied with the technical and interpersonal aspects of the consultation than non-residents, younger patients, and those with a history of trauma. CONCLUSION: Patients in the island community of Ameland experienced high levels of satisfaction with the teleradiology service offered in primary care.

Fracture diagnostics, unnecessary travel and treatment: a comparative study before and after the introduction of teleradiology in a remote general practice.

BACKGROUND: Teleradiology entails attainment of x-rays in one location, transfer over some distance and assessment at another location for diagnosis or consultation. This study documents fracture diagnostics, unnecessary trips to the hospital, treatment and number of x-rays for the years 2006 and 2009, before and after the introduction of teleradiology in a general practice on the island of Ameland in the north of the Netherlands. METHODS: In a retrospective, descriptive, observational before and after study of the introduction of x-ray facilities in an island-based general practice, we compared the number of accurately diagnosed fractures, unnecessary trips, treatments and number of x-rays taken in 2006 when only a hospital x-ray facility was available 5 hours away with those in 2009 after an x-ray facility became available at a local general practice. All patients visiting a general practice on the island of Ameland in 2006 and 2009 with trauma and clinical suspicion of a fracture, dislocation or sprain were included in the study. The initial clinical diagnoses, including those based on the outcomes of x-rays, were compared for the two years and also whether the patients were treated at home or in hospital. RESULTS: A total of 316 and 490 patients with trauma visited a general practice in 2006 and 2009, respectively. Of these patients, 66 and 116 were found to have fractures or dislocations in the two years, respectively. In 2006, 83 x-rays were ordered; in 2009, this was 284. In 2006, 9 fractures were missed; in 2009, this was only 2. In 2006, 15 patients with fractures or dislocations were treated at the general practice; in 2009, this had increased to 77. CONCLUSION: Since the introduction of teleradiology the number of missed fractures in patients visiting the general practice with trauma and the number of the unnecessary trips to a hospital are reduced. In addition more patients with fractures and dislocations can be treated in the general practice as opposed to the hospital.

[No visible strings during an IUD check-up]. / Geen draadjes zichtbaar bij controle hormoonspiraal.

BACKGROUND: When there are no strings visible during an IUD (intrauterine device) check-up and ultrasound does not show an IUD in the uterine cavity, expulsion is commonly assumed. If the patient has abdominal pain further investigation is advised. This case shows that this policy does not cover every eventuality. CASE DESCRIPTION: The patient is a 32-year-old gravida 2, para 2. One month after IUD insertion she developed abdominal pain. The strings of the IUD were not visible with a speculum and ultrasound revealed an empty uterine cavity. Over the next few years the abdominal pain decreased but she developed atypical symptoms that were interpreted as psychosocial in origin. Two years later she presented with new abdominal symptoms and we referred her to a gynaecologist. An abdominal overview X-ray image revealed the IUD, which was removed laparoscopically. CONCLUSION: If there are no strings visible at an IUD check-up, perforation of the uterus needs to be considered. An abdominal overview X-ray image, which is relatively cheap and non-invasive, can then easily be taken.

[Ill after drinking untreated milk; 'die Amelander Krankheit']. / Ziek na drinken rauwe melk; 'die Amelander Krankheit'.

In 2012 three patients consulted their general practitioner with symptoms of gastro-enteritis with bloody stools. This was caused by drinking untreated milk infected with Campylobacter jejuni. Another patient developed reactive arthritis. He too had drunk untreated milk that had probably been infected with Yersinia enterocolitica. Between 1958 and 1995 many German children living in the region of Cologne developed gastro-enteritis after holidaying on Ameland, one of the Dutch islands. This condition was known as 'die Amelander Krankheit', and was caused by drinking untreated milk that had been infected with Campylobacter jejuni. After instructions to boil the milk before drinking were followed, the illness disappeared. These cases show that consumption of untreated milk can have negative consequences for health. Hence, if patients develop gastroenteritis symptoms after visiting a farm we recommend that the possibility that they may have drunk untreated milk is taken into account.

[Teleradiology in a family practice on the Dutch island of Ameland: a cost-benefit analysis]. / Teleradiologie in de huisartsenpraktijk op Ameland: een kosten-batenanalyse.

OBJECTIVE: To calculate the costs and benefits of the introduction of teleradiology at a general practice on the Dutch island of Ameland from the perspectives of three different entities: (a) the family doctor (investor); (b) patients; and (c) health insurance companies. DESIGN: Descriptive, cost-benefit analysis. METHOD: For the year 2009, one and a half years after the introduction of a teleradiology facility at a general practice in Ameland, the operational and financing costs, the patient's saved travel time and expenses and the teleradiology costs for health insurance companies were compared with the costs that would have been made without teleradiology. RESULTS: In 2009, 426 X-rays had been taken at the general practice of which 241 for trauma and 185 for non-traumatic cases. With a reimbursement of € 100 per X-ray taken during normal working hours and € 200 for those taken during evenings and weekends, benefits for the family doctor (investor) were € 46,698 and the costs amounted to € 45,710, or a positive balance of € 980. Patients' savings in travel time and expenses were calculated at € 111,068. Health insurance companies reimbursed a minimum of € 89,265 less on diagnosis and treatment. CONCLUSION: The introduction of teleradiology a general practice in Ameland resulted in a considerable cost reduction for patients as well as for health insurance companies. In the future, diagnosing in this manner could be expanded in particular to regions in which the distances to hospitals are greater: a part of secondary healthcare could be conducted at a reduced cost.