Ultrasound screening during annual visits for older patients frequently identifies abnormalities and new chronic conditions. And implementing these exams during wellness visits may be highly beneficial, authors argued in a new analysis.
Standard Medicare Wellness checkups require no physical exam beyond blood pressure, and many doctors perform limited assessments in these situations, authors wrote in the Journal of Ultrasound in Medicine. But providers from Minneapolis-based Allina Health instituted a primary care clinic US program to determine the benefits of preventative ultrasound.
The effort proved successful, leading to meager follow-up testing costs and high patient acceptance marks.
“One or more abnormalities were found in 94% of our participants, the great majority of which would have been undetected by a traditional physical exam,” Terry K. Rosborough, MD, of Northwestern Memorial Hospital’s Department of Graduate Medical Education, and colleagues wrote July 17. “Many participants benefitted from the information and harm was rare and only economic.”
The program employed an experienced physician to perform US screening in patients 65-85 years old during their annual Medicare Wellness visits. Overall, only 108 people were examined, leading to 283 abnormalities and 172 new diagnoses.
Abdominal findings most often included liver steatosis and kidney cysts, while cardiovascular abnormalities typically consisted of carotid plaque, tricuspid valve regurgitation and left ventricular diastolic dysfunction.
Doctors ordered 30 total follow-ups, resulting in no added costs for 76% of patients. Fifteen percent faced tabs between $5-$50.
Without using a physician trained in ultrasound, however, those costs would have likely increased, the authors noted. Additionally, their equipment totaled $50,000, and only about half of patients qualified for US screening. It wouldn’t make sense to lengthen every visit, they added.
Rosborough and co-authors said screening during these appointments is at least “mildly beneficial,” but more research is needed.
“A larger study with multiple US-enabled physicians would be required to assess the generalizability and cost-effectiveness of an US screening exam as part of a wellness visit,” the authors added. “We continue to investigate how to implement an US screening exam for select patients having periodic health visits.”