title: Utilisation of a direct access echocardiography service by general practitioners in a remote and rural area--distance and rurality are not barriers to referral.
abstract: BACKGROUND
  This study aimed to examine whether general practitioner (GP) practice locations in remote and rural areas affected the pattern of direct access echocardiography referral and to assess any variations in echocardiographic findings.
  
  
  METHODS
  All referrals made by all GP practices in the Scottish Highlands over a 36-month period were analysed. Referral patterns were examined according to distance and rurality based on the Scottish Government's Urban-Rural Classification. Reasons for referral and cardiac abnormality detection rates were also examined.
  
  
  RESULTS
  In total, 1188 referrals were made from 49 different GP practices; range of referral rates was 0.3-20.1 per 1000 population with a mean of 6.5 referrals per 1000 population. Referral rates were not significantly different between urban and rural practices after correction for population size. There was no correlation between the referral rates and the distance from the centre (r2=0.004, p=0.65). The most common reason for referral was the presence of new murmur (46%). The most common presenting symptom was breathlessness (44%). Overall, 28% of studies had significant abnormal findings requiring direct input from a cardiologist. There was no clear relationship between referral rates and cardiac abnormality detection rates (r2=0.07, p=0.37). The average cardiac abnormality detection rate was 56%, (range 52-60%), with no variation based on rurality (p=0.891).
  
  
  CONCLUSIONS
  In this cohort, rurality and distance were not barriers to an equitable direct access echocardiography service. Cardiac abnormality detection rates are consistent with that of other studies.
authors.affiliation: Cardiorespiratory Department, Raigmore Hospital, Inverness, Inverness-shire, UK. alfredwaikah@gmail.com.
authors.forename: Wai K
authors.initials: WK
authors.lastname: Choo
authors.affiliation: Cardiorespiratory Department, Raigmore Hospital, Inverness, Inverness-shire, UK. katie.mcgeary@nhs.net.
authors.forename: Katie
authors.initials: K
authors.lastname: McGeary
authors.affiliation: Cardiorespiratory Department, Raigmore Hospital, Inverness, Inverness-shire, UK. colin.farman@nhs.net.
authors.forename: Colin
authors.initials: C
authors.lastname: Farman
authors.affiliation: Cardiorespiratory Department, Raigmore Hospital, Inverness, Inverness-shire, UK. andre.greyling@nhs.net.
authors.forename: Andre
authors.initials: A
authors.lastname: Greyling
authors.affiliation: Cardiorespiratory Department, Raigmore Hospital, Inverness, Inverness-shire, UK. stephen.cross@nhs.net.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Cross
authors.affiliation: Cardiorespiratory Department, Raigmore Hospital, Inverness, Inverness-shire, UK. stephen.leslie@nhs.net.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Leslie
mesh_terms: D000554:Ambulatory Care Facilities; D004452:Echocardiography / Q000706:statistics & numerical data*; D058005:General Practitioners; D006297:Health Services Accessibility; D006801:Humans; D008485:Medical Audit; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012606:Scotland
keywords: Cardiovascular health; Economics; Europe