title: Fracture diagnostics, unnecessary travel and treatment: a comparative study before and after the introduction of teleradiology in a remote general practice.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: General Practice Ballum, 9162 ET, Ballum, Ameland, The Netherlands. jjwmjacobs@gmail.com.|Health Psychology Section, University Medical Centre Groningen, University of Groningen, 9712 CP, Groningen, The Netherlands. jjwmjacobs@gmail.com.
authors.forename: Jac J W M
authors.initials: JJ
authors.lastname: Jacobs
authors.affiliation: Faculty of Economics and Business, University of Groningen, 9712 CP, Groningen, The Netherlands. j.p.a.m.jacobs@rug.nl.
authors.forename: Jan P A M
authors.initials: JP
authors.lastname: Jacobs
authors.affiliation: Health Psychology Section, University Medical Centre Groningen, University of Groningen, 9712 CP, Groningen, The Netherlands. F.L.P.van.Sonderen@umcg.nl.
authors.forename: Eric
authors.initials: E
authors.lastname: van Sonderen
authors.affiliation: Department of Primary Care, University Medical Centre Groningen, University of Groningen, 9712 CP, Groningen, The Netherlands. t.van.der.molen@umcg.nl.
authors.forename: Thys
authors.initials: T
authors.lastname: van der Molen
authors.affiliation: Health Psychology Section, University Medical Centre Groningen, University of Groningen, 9712 CP, Groningen, The Netherlands. R.Sanderman@umcg.nl.|Department of Psychology, Health and Technology, University of Twente, 7522, NB, Enschede, The Netherlands. R.Sanderman@umcg.nl.
authors.forename: Robbert
authors.initials: R
authors.lastname: Sanderman
mesh_terms: D005194:Family Practice / Q000458:organization & administration; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000628:therapy; D058006:General Practice / Q000458:organization & administration*; D006801:Humans; D009426:Netherlands; D011859:Radiography; D012189:Retrospective Studies; D019035:Rural Health Services / Q000458:organization & administration*; D019112:Teleradiology; D014195:Travel / Q000706:statistics & numerical data*