The Benefits and Barriers of Using Point-of-Care Ultrasound in Primary Healthcare in the United States

Abstract

An effective healthcare system should embrace practices that enhance overall quality and productivity. Training primary care physicians in Point-of-Care Ultrasound (POCUS) has become part of the processes that improve the quality of patient care and serve to guide the diagnostic impression quickly and effectively. With the purpose of highlighting the applications and challenges of POCUS use in US primary health care, we conducted a narrative review based on PubMed-indexed and Cochrane Library English text publications searched in May-July 2022 using a combination of key terms including point of care ultrasound, primary care, and US healthcare. Many studies have shown that POCUS has a positive impact on fostering medical attention and reducing morbidity, mortality, and healthcare costs. Besides assisting in procedures, POCUS has a head-to-toe application in evaluating inflammatory and infectious conditions, acute abdomen, cardiopulmonary function, musculoskeletal and vascular pathologies. However, its uniform implementation is limited across the US healthcare system due to multitudes of barriers such as lack of training, resource scarcity, and low reimbursement. Training primary care physicians in general and emergency care providers, in particular, is key to scaleup POCUS use. Large size studies are paramount to further explore the effectiveness of POCUS and identify key challenges to its implementation.

POCUS for Thrombus: Emphasizing the Importance of Initial Point-of-Care Ultrasound in the Management of Pulmonary Thromboembolism

“…While this case reinforces the need for consistent use of POCUS for the diagnosis of thromboembolic conditions, it is necessary to highlight that POCUS has a wide range of applications in the management of various diseases. POCUS has been shown to be useful in the diagnosis of numerous disease conditions in almost any organ system of the human body [ 18 , 19 ]. These conditions range from abdominal pathologies, such as aortic aneurysm, appendicitis, small bowel obstruction, ascites, cholelithiasis, renal abscess, hydronephrosis, pyelonephritis, and nephrolithiasis [ 18 , 19 ]; heart and lung diseases, including PE, heart failure, pulmonary edema, and airway compromise [ 18 , 19 ]; and diseases of the skin and soft tissues, including cellulitis, infections, and abscess [ 18 , 19 ].…”

“…POCUS has been shown to be useful in the diagnosis of numerous disease conditions in almost any organ system of the human body [ 18 , 19 ]. These conditions range from abdominal pathologies, such as aortic aneurysm, appendicitis, small bowel obstruction, ascites, cholelithiasis, renal abscess, hydronephrosis, pyelonephritis, and nephrolithiasis [ 18 , 19 ]; heart and lung diseases, including PE, heart failure, pulmonary edema, and airway compromise [ 18 , 19 ]; and diseases of the skin and soft tissues, including cellulitis, infections, and abscess [ 18 , 19 ]. In addition, POCUS is used in the management of obstetrics cases, such as confirming pregnancy and in the detection of ectopic pregnancy and abortions [ 18 , 19 ].…”

Time to FOCUS - ‘Palliative Medicine Point-of-Care Ultrasound’

“…[57] Performance of visceral sympathetic blocks, peripheral nerve blocks, fascial plane blocks, ganglion blocks, musculoskeletal pain interventions, corticosteroid injections, botulinum toxin injections (for troublesome siallorhea secondary to progressive neurological diseases) and securing definitive vascular access are POCUS-based interventions in palliative care setup. [1,10,58] POCUS applications possess the advantage over other conventional modalities of radiological imaging (X-ray, fluoroscopy and computed tomography) by being available bedside, avoiding ionising radiation exposure, the risk associated with contrast exposure, function as a combined diagnostic as well as an interventional tool, portable and bring cost efficacy. Renal damage secondary to intravenous contrast in a debilitated patient may predispose to further debility.…”

“…[ 57 ] Performance of visceral sympathetic blocks, peripheral nerve blocks, fascial plane blocks, ganglion blocks, musculoskeletal pain interventions, corticosteroid injections, botulinum toxin injections (for troublesome siallorhea secondary to progressive neurological diseases) and securing definitive vascular access are POCUS-based interventions in palliative care setup. [ 1 , 10 , 58 ]…”

Utility of Point-of-Care Ultrasound in A Resource-Limited Health Care Setting in Southeast Ghana: A Needs Assessment

“…Many proven benefits of POCUS are increasingly recognized, including being noninvasive, cost-effec�ve, and of significant diagnos�c value. Evidence for these benefits has been replicated in variable se�ngs for both imaging and guiding medical procedures in primary care as well as cri�cal care and neonatal cri�cal care 8,9 .…”