Danish general practitioners have found their own way of using point-of-care ultrasonography in primary care: a qualitative study

Abstract

Background General practitioners increasingly use point-of-care ultrasonography despite a lack of evidence-based guidelines for their appropriate use in primary care. Little is known about the integration of ultrasonography in general practice consultations and the impact of its use on patient care. The purpose of this study was to explore general practitioners’ experiences of using ultrasonography in the primary care setting. Methods Adopting an explorative phenomenological approach, we performed semi-structured interviews with general practitioners who used ultrasonography in their daily work. Thirteen general practitioners were recruited stepwise, aiming for maximum variation in background characteristics. Interviews were conducted at the general practitioner’s own clinic. Transcription and systematic text condensation analysis began immediately after conducting each interview. Results The general practitioners described using ultrasonography for both selected focused examinations and for explorative examinations. The two types of examinations were described differently for each of the following emerging themes: motivation for using ultrasonography, ultrasonography as part of the consultation, selection of an ultrasound catalogue , and consequences of the general practitioner’s ultrasound examination . The general practitioners had chosen and integrated their own individual ultrasound catalogue of focused examinations as a natural part of their consultations. The focused examinations were used to answer simple clinical questions and they had a significant impact on the patients’ diagnoses, clinical pathways and treatments. The general practitioners considered their own catalogue of focused examinations as their comfort zone. However, they also performed explorative ultrasound examinations outside their catalogue. These scans were performed to train, gain or maintain ultrasound competences or as explorative examinations driven by curiosity. The explorative ultrasound examinations rarely had an impact on patient care. Conclusions This study describes how general practitioners found their own way of using ultrasonography in general practice and selected a personal catalogue of ultrasound examinations that was applicable, relevant and meaningful for their daily clinical routines. This study may serve to inform implementation strategies in general practice by offering insights into central aspects that drive general practitioners’ behaviours. Electronic supplementary material The online version of this article (10.1186/s12875-019-0984-x) contains supplementary material, which is available to authorized users.

Use and impact of point-of-care ultrasonography in general practice: a prospective observational study

“…Another explanation may relate to patient encounters in Danish general practice. A previous qualitative study has described how Danish GPs perform POCUS examinations that they consider relevant in their patient population 16 and musculoskeletal conditions are the most common organ-specific complaints raised by patients in Danish general practice. 21 Moreover, in a recent needs assessment, pelvic ultrasound was found to be the POCUS application GPs had most interest in learning.…”

“…We found it realistic to include 20 of the GPs in the study. Based on an interview study with Danish GPs, 16 we estimated that the GPs would use POCUS 2-3 times a day. Assuming a participation rate of 80%, we expected to include 640-960 patients during the study period of 1 month.…”

“…This study had a broader sample of scanning GPs than most reported studies. Furthermore, the registration tool was developed through comprehensive qualitative work 16 and pilot testing. We designed the study to mimic daily work and to avoid recall bias in the registrations.…”

“…12 13 A few recent studies from general practice suggest the same. [14][15][16] However, little attention has been given to the specific impact of POCUS on the diagnostic process in general practice and GPs' clinical decision-making. The aim of this study was to describe how GPs use POCUS in their daily practice and how it influences the diagnostic process and the treatment of patients.…”

Effectiveness of a primary care clinical ultrasound classroom for family physicians as a formative intervention system, a quasi-experimental trial

“…In the scope of primary health care in Spain, the use of ultrasound has been generalized in the healthcare centers of all the autonomous communities, which is also happening in other European countries. [ 21 ] This is posing an important effort in the training of family physicians in the use of this tool. Currently, the ultrasound training offered by public and private entities for family physicians in Spain is abundant and of high quality, although it usually has a very academist orientation with little focus on the clinical practice.…”