Stakeholder Perceptions of Point-of-Care Ultrasound Implementation in Resource-Limited Settings

Abstract

Background: Nearly half of the world lacks access to diagnostic imaging. Point of care ultrasound (POCUS) is a versatile and relatively affordable imaging modality that offers promise as a means of bridging the radiology gap and improving care in low resource settings. Methods: We performed semi-structured interviews of key stakeholders at two diverse hospitals where POCUS implementation programs had recently been conducted: one in a rural private hospital in Haiti and the other in a public referral hospital in Malawi. Questions regarding the clinical utility of POCUS, as well as barriers and facilitators of its implementation, were asked of study participants. Using the Framework Method, analysis of interview transcripts was guided by the WHO ASSURED criteria for point of care diagnostics. Results: Fifteen stakeholders with diverse roles in POCUS implementation were interviewed. Interviewees from both sites considered POCUS a valuable diagnostic tool that improved clinical decisions. They perceived barriers to adequate training as one of the most important remaining barriers to POCUS implementation. Conclusions: In spite of the increasing affordability and portability of ultrasounds devices, there are still important barriers to the implementation of POCUS in resource-limited settings.

Feasibility, usability and acceptability of paediatric lung ultrasound among healthcare providers and caregivers for the diagnosis of childhood pneumonia in resource-constrained settings: a qualitative study

“…Our findings were similar to prior qualitative research on the implementation of point-of-care ultrasound and more broadly, point-of-care diagnostics in LMIC. 30–32 Key stakeholder perspectives revealed that training as well as cost and maintenance of materials were major barriers to use, while improved diagnostic accuracy, timely diagnosis and portability were major benefits. 30–32 When considering point-of-care diagnostics more broadly, stakeholders emphasised cost-effectiveness evaluations and improving quality management systems, again supporting the importance of cost containment and quality of healthcare delivery through trained staff and functional equipment for sustainability.…”

“…[30][31][32] Key stakeholder perspectives revealed that training as well as cost and maintenance of materials were major barriers to use, while improved diagnostic accuracy, timely diagnosis and portability were major benefits. [30][31][32] When Open access considering point-of-care diagnostics more broadly, stakeholders emphasised cost-effectiveness evaluations and improving quality management systems, again supporting the importance of cost containment and quality of healthcare delivery through trained staff and functional equipment for sustainability. 31 Acceptance and adoption of new technology Quality control and device functionality ensure that the building blocks for successful implementation are in place and can be sustained over time.…”

Hospitalist perspectives of available tests to monitor volume status in patients with heart failure: a qualitative study

“…The semi-structured interview guide was designed to explore hospitalists’ perceptions and attitudes toward current tools available to evaluate for volume status, parameters to determine discharge-readiness, utility of lung ultrasound and the factors that influence its adoption (see Supplementary Material). All interviews were conducted by a physician with prior experience with qualitative interviews[16] (AMM).…”

Hospitalist Perspectives of Available Tests to Monitor Volume Status in Patients With Heart Failure: A Qualitative Study

“…The semi-structured interview guide was designed to explore hospitalists' perceptions and attitudes toward current tools available to evaluate for volume status, parameters to determine discharge-readiness, utility of lung ultrasound and the factors that influence its adoption (see Appendix). All interviews were conducted by a physician with prior experience with qualitative interviews (AM) [16].…”