Danish general practitioners have found their own way of using point-of-care ultrasonography in primary care: a qualitative study

Camilla Aakjær Andersen, Annette Sofie Davidsen, John Brodersen, Ole Graumann, Martin Bach Jensen, Camilla Aakjær Andersen, Annette Sofie Davidsen, John Brodersen, Ole Graumann, Martin Bach Jensen

Abstract

Background: General practitioners increasingly use point-of-care ultrasonography despite a lack of evidence-based guidelines for their appropriate use in primary care. Little is known about the integration of ultrasonography in general practice consultations and the impact of its use on patient care. The purpose of this study was to explore general practitioners' experiences of using ultrasonography in the primary care setting.

Methods: Adopting an explorative phenomenological approach, we performed semi-structured interviews with general practitioners who used ultrasonography in their daily work. Thirteen general practitioners were recruited stepwise, aiming for maximum variation in background characteristics. Interviews were conducted at the general practitioner's own clinic. Transcription and systematic text condensation analysis began immediately after conducting each interview.

Results: The general practitioners described using ultrasonography for both selected focused examinations and for explorative examinations. The two types of examinations were described differently for each of the following emerging themes: motivation for using ultrasonography, ultrasonography as part of the consultation, selection of an ultrasound catalogue, and consequences of the general practitioner's ultrasound examination. The general practitioners had chosen and integrated their own individual ultrasound catalogue of focused examinations as a natural part of their consultations. The focused examinations were used to answer simple clinical questions and they had a significant impact on the patients' diagnoses, clinical pathways and treatments. The general practitioners considered their own catalogue of focused examinations as their comfort zone. However, they also performed explorative ultrasound examinations outside their catalogue. These scans were performed to train, gain or maintain ultrasound competences or as explorative examinations driven by curiosity. The explorative ultrasound examinations rarely had an impact on patient care.

Conclusions: This study describes how general practitioners found their own way of using ultrasonography in general practice and selected a personal catalogue of ultrasound examinations that was applicable, relevant and meaningful for their daily clinical routines. This study may serve to inform implementation strategies in general practice by offering insights into central aspects that drive general practitioners' behaviours.

Keywords: Family medicine; General practice; Implementation; Interviews; Point-of-care ultrasound; Primary care; Qualitative methods; Ultrasonography.

Conflict of interest statement

The authors report no competing interests.

Figures

Fig. 1
Fig. 1
Systematic text condensation in this study. This figure illustrates and elaborates the analytic process in this study
Fig. 2
Fig. 2
Two ways of using ultrasonography. This figure illustrates the interaction between themes in the analysis and the distinction between selected focused ultrasound examinations and explorative ultrasound examinations within each theme

References

    1. Moore CLCJ. Point-of-care ultrasonography. N Engl J Med. 2011;364(8):749–757. doi: 10.1056/NEJMra0909487.
    1. Weile J, Brix J, Moellekaer AB. Is point-of-care ultrasound disruptive innovation? Formulating why POCUS is different from conventional comprehensive ultrasound. Crit Ultrasound J. 2018;10(1):3. doi: 10.1186/s13089-018-0106-3.
    1. Laursen CB, Sloth E, Lassen AT, Rd C, Lambrechtsen J, Madsen PH, et al. Point-of-care ultrasonography in patients admitted with respiratory symptoms: a single-blind, randomised controlled trial. Lancet Resp Med. 2014;2(8):638–646. doi: 10.1016/S2213-2600(14)70135-3.
    1. Smallwood Nicholas, Dachsel Martin. Point-of-care ultrasound (POCUS): unnecessary gadgetry or evidence-based medicine? Clinical Medicine. 2018;18(3):219–224. doi: 10.7861/clinmedicine.18-3-219.
    1. Bornemann P, Jayasekera N, Bergman K, Ramos M, Gerhart J. Point-of-care ultrasound: coming soon to primary care? J Fam Pract. 2018;67(2):70–80.
    1. Genc A, Ryk M, Suwala M, Zurakowska T, Kosiak W. Ultrasound imaging in the general practitioner's office - a literature review. J Ultrason. 2016;16(64):78–86. doi: 10.15557/JoU.2016.0008.
    1. Steinmetz P, Oleskevich S. The benefits of doing ultrasound exams in your office. J Fam Pract. 2016;65(8):517–523.
    1. Andersen CA, Holden S, Vela J, Ratleff MS, Jensen MB. Point-of-Care Ultrasound in General Practice:A Systematic Review. Ann Fam Med. 2019;17:61–69. doi: 10.1370/afm.2330.
    1. Carelli F. GP workloads in Europe Br J Gen Pract. 2004;54(502):390.
    1. Fisher RF, Croxson CH, Ashdown HF, Hobbs FR. GP views on strategies to cope with increasing workload: a qualitative interview study. Br J Gen Pract. 2017;67(655):e156. doi: 10.3399/bjgp17X688861.
    1. Mengel-Jorgensen T, Jensen MB. Variation in the use of point-of-care ultrasound in general practice in various European countries. Results of a survey among experts. Eur J Gen Pract. 2016;22(4):274–277. doi: 10.1080/13814788.2016.1211105.
    1. Varzgaliene L, Heerey A, Cox C, McGuinness T, McGuire G, Cals JW, O'Shea E, Kelly M. Point-of-care testing in primary care: needs and attitudes of Irish GPs. BJGP Open. 2017;15:1(4). doi: 10.3399/bjgpopen17X101229.
    1. American Academy of Family Physicians (AAFP). Recommended Curriculum Guidelines for Family Medicine Residents Point of Care Ultrasound. 2016. . Accessed 2 Feb 2019.
    1. The Danish College of General Practitioners (DSAM) Ultrasound interest group. Common trunk. 2015. . Accessed 2 Feb 2019.
    1. Facebook group: Ultralyd i almen praksis i Danmark (Ultrasound in Danish general practice). Accessed 2 Feb 2019.
    1. The Danish College of General Practitioners (DSAM) Ultrasound interest group. Annual report 2016–2017. . Accessed 2 Feb 2019.
    1. Lau R, Stevenson F, Ong BN, Dziedzic K, Treweek S, Eldridge S, et al. Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews. Implement Sci. 2016;11(1):40. doi: 10.1186/s13012-016-0396-4.
    1. Giorgi A. Sketch of a psychological phenomenological method. In: Giorgi A, editor. Phenomenology and psychological research. Pittsburgh: Duquesne University Press; 1985. pp. 8–22.
    1. Malterud K, Siersma VD, Guassora AD. Sample size in qualitative interview studies: guided by information power. Qual Health Res. 2016;26(13):1753–1760. doi: 10.1177/1049732315617444.
    1. Malterud K. Systematic text condensation: a strategy for qualitative analysis. Scand J Public Health. 2012;40(8):795–805. doi: 10.1177/1403494812465030.
    1. OECD/EU . Health at a glance. Europe: State of Health in the EU Cycle, OECD Publishing, Paris/EU, Brussels; 2018.
    1. Schäfer W. Primary care in 34 countries:perspectives of general practitioners and their patients. Netherlands: NIVEL, Netherlands Institute for Health Services Research, Utrecht; 2016.
    1. Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6(1):42. doi: 10.1186/1748-5908-6-42.
    1. Dreyfus SDH. In: University of California, editor. A five-stage model of the mental activities involved in directed skill acquisition.&nbsp. Berkeley, US, Operations Research Centre; 1980.
    1. Carraccio CL, Benson BJ, Nixon LJ, Derstine PL. From the educational bench to the clinical bedside: translating the Dreyfus developmental model to the learning of clinical skills. Acad Med. 2008;83(8):761–767. doi: 10.1097/ACM.0b013e31817eb632.
    1. Piscaglia F, Dietrich CF, Nolsoe C, Gilja OH, Gaitini D). Birth of „Echoscopy“– The EFSUMB Point of View. Ultraschall in Med 2013; 34(1): 92. Ultraschall in Med 2013;1(34):92.
    1. Skjoldbye B, Ewertsen C, Grossjohann HS, Bendtsen T, Bolvig L. Ultralyden breder sig som ringe i vandet. Ugeskr Laeger. 2014;176:V66264.
    1. Lugtenberg M, Burgers JS, Han D, Westert GP. General practitioners' preferences for interventions to improve guideline adherence. J Eval Clin Pract. 2014;20(6):820–826. doi: 10.1111/jep.12209.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi