TY - JOUR
T1 - Use and impact of point-of-care ultrasonography in general practice
T2 - a prospective observational study
AU - Aakjær Andersen, Camilla
AU - Brodersen, John
AU - Davidsen, Annette Sofie
AU - Graumann, Ole
AU - Jensen, Martin Bach B
N1 - © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2020/9/17
Y1 - 2020/9/17
N2 - OBJECTIVES: To describe how general practitioners (GPs) use point-of-care ultrasonography (POCUS) and how it influences the diagnostic process and treatment of patients. DESIGN: Prospective observational study using an online questionnaire before and after POCUS. SETTING: Office-based general practice. PARTICIPANTS: Twenty GPs consecutively recruited all patients examined with POCUS in 1 month. PRIMARY AND SECONDARY OUTCOME MEASURES: We estimated the use of POCUS through the indication for use, the frequency of use, the time consumption, the extent of modification of the examination and the findings.The influence on the diagnostic process was estimated through change in the tentative diagnoses, change in confidence, the ability to produce ultrasound images and the relationship between confidence and organs scanned or tentative diagnoses.The influence of POCUS on patient treatment was estimated through change in plan for the patient, change in patient's treatment and the relationship between such changes and certain findings. RESULTS: The GPs included 574 patients in the study. POCUS was used in patient consultations with a median frequency of 8.6% (IQR: 4.9-12.6). Many different organs were scanned covering more than 100 different tentative diagnoses. The median time taken to perform POCUS was 5 min (IQR: 3-8). Across applications and GPs, POCUS entailed a change in diagnoses in 49.4% of patients; increased confidence in a diagnosis in 89.2% of patients; a change in the management plan for 50.9% of patients including an absolute reduction in intended referrals to secondary care from 49.2% to 25.6%; and a change in treatment for 26.5% of patients. CONCLUSIONS: The clinical utilisation of POCUS was highly variable among the GPs included in this study in terms of the indication for performing POCUS, examined scanning modalities and frequency of use. Overall, using POCUS altered the GPs' diagnostic process and clinical decision-making in nearly three out of four consultations. TRIAL REGISTRATION NUMBER: NCT03375333.
AB - OBJECTIVES: To describe how general practitioners (GPs) use point-of-care ultrasonography (POCUS) and how it influences the diagnostic process and treatment of patients. DESIGN: Prospective observational study using an online questionnaire before and after POCUS. SETTING: Office-based general practice. PARTICIPANTS: Twenty GPs consecutively recruited all patients examined with POCUS in 1 month. PRIMARY AND SECONDARY OUTCOME MEASURES: We estimated the use of POCUS through the indication for use, the frequency of use, the time consumption, the extent of modification of the examination and the findings.The influence on the diagnostic process was estimated through change in the tentative diagnoses, change in confidence, the ability to produce ultrasound images and the relationship between confidence and organs scanned or tentative diagnoses.The influence of POCUS on patient treatment was estimated through change in plan for the patient, change in patient's treatment and the relationship between such changes and certain findings. RESULTS: The GPs included 574 patients in the study. POCUS was used in patient consultations with a median frequency of 8.6% (IQR: 4.9-12.6). Many different organs were scanned covering more than 100 different tentative diagnoses. The median time taken to perform POCUS was 5 min (IQR: 3-8). Across applications and GPs, POCUS entailed a change in diagnoses in 49.4% of patients; increased confidence in a diagnosis in 89.2% of patients; a change in the management plan for 50.9% of patients including an absolute reduction in intended referrals to secondary care from 49.2% to 25.6%; and a change in treatment for 26.5% of patients. CONCLUSIONS: The clinical utilisation of POCUS was highly variable among the GPs included in this study in terms of the indication for performing POCUS, examined scanning modalities and frequency of use. Overall, using POCUS altered the GPs' diagnostic process and clinical decision-making in nearly three out of four consultations. TRIAL REGISTRATION NUMBER: NCT03375333.
KW - change management
KW - organisation of health services
KW - primary care
KW - ultrasonography
UR - http://www.scopus.com/inward/record.url?scp=85091323944&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2020-037664
DO - 10.1136/bmjopen-2020-037664
M3 - Journal article
C2 - 32948563
SN - 2044-6055
VL - 10
JO - BMJ Open
JF - BMJ Open
IS - 9
M1 - e037664
ER -