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PEDIATRICS Vol. 103 No. 4 April 1999, p. e40

ELECTRONIC ARTICLE:
Primary Care Physicians' Use of Screening Echocardiography

Received May 29, 1998; accepted Oct 19, 1998.

Andrew S. Bensky, Wesley Covitz, and Robert H. DuRant

From the Department of Pediatrics, Brenner Center for Child and Adolescent Health, Wake Forest University School of Medicine, Winston-Salem, North Carolina.

Objective.  To survey primary care physicians to understand their reasons for using echocardiography to screen for congenital heart disease in children and to assess their understanding of the costs associated with cardiology services.

Design.  A questionnaire.

Participants.  Eight hundred sixty-seven pediatricians and family physicians in our region were surveyed, 494 (57%) responded and 466 were used for the analysis.

Results.  The majority of pediatricians and family physicians in our area do not know the relative costs associated with cardiology consultation and echocardiography. They also believe it likely that a cardiologist will routinely obtain an echocardiogram as part of their evaluation of a child with a murmur, although this is not the case. The availability and convenience of specialist appointments was found to significantly influence the decision to order an echocardiogram. Family physicians were significantly more likely than pediatricians to order an echocardiogram for a variety of clinical indications.

Conclusions.  Improving primary care physicians' knowl- edge of the costs associated with cardiology services and current cardiology practice patterns, in addition to improving the availability of cardiology referrals, may reduce the number of expensive and unnecessary echocardiograms. echocardiography, heart murmur, congenital heart disease, cost-effectiveness. .


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