Patients’ experiences of the use of point-of-care ultrasound in general practice – a cross-sectional study

Abstract

Background The use of point-of-care ultrasonography (POCUS) performed by general practitioners (GPs) in primary care settings is increasing. Previous studies have focused on GP-reported outcomes and little is known about patients’ perspectives on the use of POCUS technology within the general practice consultation. The purpose of this study was to examine patients’ experiences with POCUS in general practice within the areas where GPs have indicated that POCUS affected aspects of the consultation. Methods A questionnaire was developed using a mixed methods sequential design. Analytical themes from interviews with GPs were converted into items in a questionnaire by the research team. The questionnaire was then further developed in several rounds of pilot tests involving both patients and GPs. The final questionnaire was used in a cohort study conducted in 18 Danish office-based general practice clinics from January 2018 to August 2018. All patients examined with POCUS were asked to complete the questionnaire on tablets immediately after their consultation. Results Out of 691 patients examined, 564 (81.6%) questionnaires were available for analysis. The patients reported that they were well informed about the purpose (98%) and the results (97%) of the POCUS examination; however, 29% reported that they were not informed about the difference between POCUS and an imaging-specialist’s ultrasound examination. Almost all patients (99%) reported that POCUS was integrated naturally into the consultation, and 45% reported that POCUS improved the doctor-patient relationship. The majority of patients felt that they had been more thoroughly examined (92%) and taken more seriously (58%) when POCUS was part of the consultation. They felt POCUS gave them a better understanding of their health problem (82%), made them feel more secure (86%) and increased their trust in the physician’s assessment (65%). Moreover, the patients reported that POCUS use improved the level of service (95%) they experienced and the quality of care (94%) in general practice. Conclusion We found that an examination including POCUS in general practice was a positive experience overall for the majority of patients. Future research should further explore reasons for patient confidence in POCUS and whether or not the reassuring value of POCUS is valid. Trial registration ClinicalTrials.gov Identifier: NCT03416608

Racial Disparity in Pediatric Radiography for Forearm Fractures

“…Moreover, since rural and underserved areas have lower access to healthcare resources [ 7 ], namely radiographic imaging services, implementation of non-radiographic options like POCUS equipment would be a substantially lower cost compared to x-ray, CT, or MRI [ 17 ]. Given the high-level evidence specifically supporting the use of POCUS in primary care for fracture diagnosis [ 23 , 24 ], care access for marginalized populations could be increased without the imposition of cost-sharing.…”

Point-of-care ultrasound

“…PoCUS is an essential clinical tool in prehospital and primary care practice, particularly for obstetrics and abdominal assessments 26. From the patient perspective, in one study, up to 95% of patients felt that PoCUS improved their primary care health visit, with 45% feeling that the provider-patient relationship had improved 27. There were no patients within the study that felt the PoCUS exam as part of the physical assessment provided a negative experience 27.…”

General Practitioners’ Perspectives on Appropriate Use of Ultrasonography in Primary Care in Denmark: A Multistage Mixed Methods Study

“…36 Given the discrepancy between the GPs' perspectives on appropriate use and their actual practice, efforts to guide GPs venturing into POCUS use are needed. Patients seem to appreciate the use of POCUS, 37,38 but questions remain regarding the reliability and diagnostic accuracy of a GP POCUS scan 30 and the challenges of evaluating and monitoring technology based in the community. 39,40 Until data is available for developing evidence-based guidelines 11 about appropriate and inappropriate POCUS use in general practice, interim experience-based recommendations based on basic ethical clinical principles, eg, primum non nocere (first, do no harm), may guide and encourage prudence among GPs (Figures 1-4).…”