Point-of-care ultrasound (POCUS) in Norwegian general practice

Myklestul, Hans-Christian; Skonnord, Trygve; Brekke, Mette

doi:10.1080/02813432.2020.1753385

Cited by 14 publications

(20 citation statements)

References 18 publications

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“…Today, POCUS in general practice in Denmark is limited to highly motivated GPs, willing to invest much time and money. However, the use of POCUS in general practice is increasing [ 10 , 12 ]. The variation in training and individual learning strategies for achieving and maintaining POCUS proficiency found in this study suggests the need for more explicit recommendations regarding which POCUS competences GPs should obtain and how they should be obtained before venturing into using POCUS in general practice.…”

Section: Discussionmentioning

confidence: 99%

Learning strategies of general practitioners striving to achieve point-of-care ultrasound competence: a qualitative study

Andersen

Espersen

Brodersen

et al. 2022

Scandinavian Journal of Primary Health Care

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Background Point-of-care ultrasonography (POCUS) is increasingly used in general practice despite the lack of official educational programmes or guidelines for general practitioners (GPs). Aim To explore how GPs have learnt to use POCUS and which barriers they have encountered in their learning process. Design and setting Qualitative study conducted in office-based general practice in Denmark. Methods Semi-structured interviews were conducted with 13 GPs who had implemented POCUS without supporting guidelines or regulations. Analysis was carried out using systematic text condensation. The interview data for this study were collected along with data used in a previous study. Results The participating GPs described having composed their own ultrasound education following a continuous learning process. Basic POCUS competences were achieved through formalized training sessions at hospital departments or courses. The GPs further developed and expanded their scanning skills through additional courses and continuous self-study practice on patients often while consulting internet sources, textbooks or colleagues. Lack of available ultrasound courses, supervision, and clinical guidelines together with time constraints and financial aspects were mentioned as barriers to their ultrasound training. Conclusion This study showed how GPs had composed their own ultrasound education individually and differently, guided by their own experiences and beliefs about good clinical practice. Formalized ultrasound training was considered a prerequisite for achieving basic ultrasound competences while continuous practice was considered paramount to develop and maintain scanning skills. There were several obstacles to overcome in the learning process including lack of supervision, guidance, and opportunity for practicing skills. Key points Little is known about the educational needs of general practitioners striving to achieve ultrasound competences. General practitioners described using formalized training to achieve basic scanning competences and continuous self-study and practice to further develop their skills. Lack of time, supervision, clinical guidelines and ultrasound courses were considered barriers in the learning process together with financial aspects.

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Section: Discussionmentioning

confidence: 99%

Learning strategies of general practitioners striving to achieve point-of-care ultrasound competence: a qualitative study

Andersen

Espersen

Brodersen

et al. 2022

Scandinavian Journal of Primary Health Care

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“…General practitioners (GPs) are increasingly using point-of-care ultrasound (POCUS) in their examination of selected patients [ 4 – 6 ]. Patients may regard diagnostic POCUS as an improved service to ensure earlier and more correct diagnosis and treatment.…”

Section: Introductionmentioning

confidence: 99%

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

Andersen

Brodersen

Rudbæk³

et al. 2021

BMC Fam Pract

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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

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“…The use of POCUS may lead to more efficient diagnostics [ 7 , 10 ] and is likely more cost-effective than ultrasound in secondary health care. The use of POCUS has increased over the last few years, and in 2016 30% of Norwegian GPs used ultrasound, however, three out of four GPs performed less than 10 scans annually [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Handheld transabdominal ultrasound, after limited training, may confirm first trimester viable intrauterine pregnancy: a prospective cohort study

Pedersen

Sira

Trovik

2021

Scandinavian Journal of Primary Health Care

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Objectives: Handheld point-of-care abdominal ultrasound (POCUS) may be used by primary care physicians while vaginal ultrasound is limited to use in specialist care. We aimed to compare abdominal handheld ultrasound to vaginal ultrasound in determining first trimester viable intrauterine pregnancy and estimate gestational length. Design: Prospective cohort study. Setting: Gynaecologic outpatient clinic; women referred from GPs during early pregnancy. Handheld ultrasound using VscanExtend V R was performed by fourth-year medical students with limited training. Transvaginal ultrasound using high-end devices was performed by ordinary hospital staff. Subjects: Women in the first trimester of pregnancy referred for termination of pregnancy or with symptoms of early pregnancy complications. Main outcome measures: Rate of confirming vital intrauterine pregnancy (visualizing foetal heart beats) and measurement of crown-rump length (CRL) using handheld abdominal versus vaginal ultrasound. Results: In all 100 women were included; 86 confirmed as viable intrauterine pregnancies and 14 pathological pregnancies (miscarriages/extrauterine pregnancies). Handheld abdominal ultrasound detected fetal heartbeats in 63/86 (73% sensitivity) of healthy pregnancies and confirmed lack of fetal heartbeats in all pathological pregnancies, total positive predictive value (PPV) 100% and total negative predictive value (NPV) 38%. From gestational week 7, handheld abdominal ultrasound confirmed vitality in 51/54 patients: PPV 100% and NPV 79%. CRL (n ¼ 62) was median 1 mm shorter (95% confidence interval 1-2 mm) measured by handheld abdominal versus vaginal ultrasound. Conclusion:Handheld ultrasound has an excellent prediction confirming viable intrauterine pregnancy from gestational week 7. Validation studies are needed to confirm whether the method is suitable in primary care assessing early pregnancy complications. KEY POINTSWhen early pregnancy vitality needs to be confirmed, women will traditionally be referred to secondary care for transvaginal comprehensive ultrasonography performed with high-end devices by imaging specialists. In this study personnel with limited former training (fourth-year medical students) performed transabdominal POCUS using a handheld device, investigating 100 first trimester pregnancies for confirmation of viability. Using handheld ultrasound viable pregnancy was confirmed from gestational week 7 with 79% positive and 100% negative predictive value. If handheld ultrasound used in primary care confirms vital intrauterine pregnancy, the need for specialist referral could be reduced.

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Point-of-care ultrasound (POCUS) in Norwegian general practice

Abstract: Objective: To assess the use of point-of-care ultrasound (POCUS) in Norwegian general practice.

Cited by 14 publications

References 18 publications

Learning strategies of general practitioners striving to achieve point-of-care ultrasound competence: a qualitative study

Learning strategies of general practitioners striving to achieve point-of-care ultrasound competence: a qualitative study

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

Handheld transabdominal ultrasound, after limited training, may confirm first trimester viable intrauterine pregnancy: a prospective cohort study

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