TY - JOUR

T1 - Use and impact of point-of-care ultrasonography in general practice

T2 - a prospective observational study

AU - Aakjaer Andersen, Camilla

AU - Brodersen, John

AU - Davidsen, Annette Sofie

AU - Graumann, Ole

AU - Jensen, Martin Bach B.

PY - 2020

Y1 - 2020

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.

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.

KW - primary care

KW - ultrasonography

KW - change management

KW - organisation of health services

KW - HAND-CARRIED ULTRASOUND

KW - POCUS

U2 - 10.1136/bmjopen-2020-037664

DO - 10.1136/bmjopen-2020-037664

M3 - Journal article

C2 - 32948563

VL - 10

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 9

M1 - 037664

ER -