title: Clinicians' attitudes towards endoscopic ultrasound: a survey of four European countries.
abstract: OBJECTIVE
  Despite the documented effectiveness of endoscopic ultrasound (EUS) in research studies, data on the utilization of this technology in clinical practice are scarce. The aim of this study was to assess EUS availability and accessibility as well as EUS utilization among clinicians from different European countries.
  
  
  METHODS
  A direct mail survey was sent to members of the national gastroenterological associations in Sweden, Norway, Greece, and the United Kingdom.
  
  
  RESULTS
  Out of 2361 clinicians with valid addresses, 593 (25.1%) responded. Overall, EUS was available to 43% of clinicians within their practice but availability varied from 23% in Greece to 56% in the United Kingdom. More than 50% of respondents evaluating patients with esophageal cancer, rectal cancer, or pancreaticobiliary disorders had utilized EUS during the previous year, but utilization varied considerably among different countries, being more frequent in the United Kingdom. In logistic regression analyses, factors independently related to EUS utilization were mainly EUS availability and accessibility as well as perceived utility of EUS (p <0.05 for all). Respondents considered the lack of trained endosonographers (79%) and high cost (52%) as the main barriers to wider EUS use.
  
  
  CONCLUSIONS
  The majority of responding clinicians use EUS but overall utilization varies considerably among different countries. There is considerable variation in EUS service availability and accessibility among countries which, together with perceived usefulness of EUS, is a major determinant of EUS utilization. A shortage of trained endosonographers and the high cost are major barriers to wider EUS use. The findings of this study might help to define policies aimed at development of EUS services.
authors.affiliation: Department of Gastroenterology, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK. evangelos.kalaitzakis@vgregion.se
authors.forename: Evangelos
authors.initials: E
authors.lastname: Kalaitzakis
authors.forename: Marios
authors.initials: M
authors.lastname: Panos
authors.forename: Riadh
authors.initials: R
authors.lastname: Sadik
authors.forename: Lars
authors.initials: L
authors.lastname: Aabakken
authors.forename: Andriani
authors.initials: A
authors.lastname: Koumi
authors.forename: John
authors.initials: J
authors.lastname: Meenan
mesh_terms: D001291:Attitude of Health Personnel; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging; D004066:Digestive System Diseases / Q000000981:diagnostic imaging* / Q000191:economics; D019160:Endosonography / Q000191:economics / Q000706:statistics & numerical data*; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging; D006115:Greece; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D009664:Norway; D010182:Pancreatic Diseases / Q000000981:diagnostic imaging; D010818:Practice Patterns, Physicians'; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging; D011795:Surveys and Questionnaires; D013548:Sweden; D006113:United Kingdom