Introducing point-of-care ultrasound in Danish general practice-elucidating the use through a medical audit.

BACKGROUND: Point-of-care ultrasonography (PoCUS) is increasingly used across the medical field. PoCUS is also being implemented in general practice despite a lack of clinical guidelines and training programs for general practitioners (GPs). OBJECTIVES: This study aimed to elucidate the employment of PoCUS by Danish GPs following a short training program. METHODS: Thirty GPs were enrolled in a short ultrasound training program and taught how to perform 22 selected scanning modalities. In the following 3 months, the GPs registered all performed PoCUS examinations according to the Audit Project Odense method. After 5 months, the GPs were invited to participate in an evaluation seminar, where questionnaires were distributed. RESULTS: During the registration period, 1598 patients were examined with PoCUS. A total of 1948 scanning modalities were registered, including 207 examinations outside the taught curriculum. The majority of the ultrasound examinations were performed within 10 minutes (89%), most were considered to be conclusive (87%) and/or to increase diagnostic certainty (67%), whereas one in four examinations entailed a change in patient management. Most GPs attending the evaluation seminar continued to use PoCUS and found the scanning modalities included in the course curriculum relevant in their daily work. CONCLUSION: The GPs found several indications for performing PoCUS following the attendance of a 2-day basic training program. The majority of examinations were registered to be conclusive and/or increase diagnostic certainty. However, few GPs used PoCUS on a daily basis and not all examinations were registered to have an impact on patient care.

Education of general practitioners in the use of point-of-care ultrasonography: a systematic review.

OBJECTIVE: To systematically review and synthesize the published literature regarding the education of general practitioners (GPs) and GPs in training (GPTs) in the use of ultrasonography. DESIGN: This systematic review was prospectively registered in PROSPERO, conducted according to the Cochrane recommendations. We combined studies identified in a previous systematic review with studies from an updated literature search using the same search string. We searched the following databases: MEDLINE via Pubmed, EMBASE via OVID, Cinahl via Ebsco, Web of Science and Cochrane Register of Controlled Trials using the words 'ultrasonography' and 'general practice'. Two reviewers independently screened articles, extracted data and assessed the quality of included papers according to the Down and Black quality assessment tool. Disagreements were resolved by involving a third reviewer. RESULTS: Thirty-three papers were included. Ultrasound training was described to include both theoretical and practical training sessions. Theoretical training was achieved through introductory e-learning and/or didactic lectures. Practical training included focussed hands-on training sessions, while some papers described additional longitudinal practical training through proctored scans during clinical work or through self-study practice with continuous feedback on recorded scans. CONCLUSION: There was a large variation in ultrasound training programs for GPs and GPTs, with an overall emphasis on focussed practical training. Few studies included a longitudinal learning process in the training program. However, diagnostic accuracy seemed to improve with hours of practical training, and studies including continuous feedback on scans conducted during clinical patient encounters showed superior results.

Point-of-care ultrasonography is increasingly used by general practitioners (GPs) working in primary care as a diagnostic tool providing earlier and more precise diagnoses. However, ultrasonography is a user-dependent technology and obtaining competence requires both training and practice. Today, there is no consensus about which ultrasound training GPs should have before they start scanning patients in their clinics.

Point-of-care ultrasound for general practitioners: a systematic needs assessment.

Objective: The aim of the study was to achieve consensus among a group of ultrasound proficient general practitioners (GPs) from Denmark, Norway, Sweden and Finland on which ultrasound scanning modalities and ultrasound-guided procedures are essential to GPs in their daily work for the purpose of including them in a basic ultrasound curriculum.Design: The Delphi methodology was used to obtain consensus.Subjects: Sixty Scandinavian GPs with more than two years of point-of-care ultrasound (POCUS) experience were invited to join the Delphi expert panel.Main outcome measures: In the first Delphi round each member of the panel was asked to produce a list of scanning modalities and procedures which they found relevant to include in a basic ultrasound curriculum. In Delphi round two, these suggestions were presented to the entire panel who assessed whether they found them essential in their daily work. Items not reaching consensus in round two, were presented to the panel in a third and final round. Items reaching more than 67% agreement were included.Results: Forty-five GPs were included in the study and 41 GPs completed all rounds. Agreement was obtained on 30 scanning modalities and procedures primarily within the musculoskeletal (8), abdominal (5), obstetric (5) and soft tissue (3) diagnostic areas. Four ultrasound-guided procedures were also agreed upon.Conclusion: A prioritized list of 30 scanning modalities and procedures was agreed upon by a group of ultrasound proficient GPs. This list could serve as a guideline when planning future POCUS educational activities for GPs.Key pointsPoint-of-care ultrasound (POCUS) is increasingly being used by general practitioners (GPs), but little is known about which ultrasound applications are most used.We performed a systematic needs assessment among a group of ultrasound proficient GPs using the Delphi methodology for the purpose of establishing a basic POCUS curriculum.The process resulted in a prioritized list of 30 scanning modalities and ultrasound guided procedures.Our study provides the basis for an evidence-based basic POCUS curriculum for GPs.

Good quality of oral anticoagulation treatment in general practice using international normalised ratio point of care testing.

INTRODUCTION: Oral anticoagulation treatment (OACT) with warfarin is common in general practice. Increasingly, international normalised ratio (INR) point of care testing (POCT) is being used to manage patients. The aim of this study was to describe and analyse the quality of OACT with warfarin in general practice in the Capital Region of Denmark using INR POCT. METHODS: A total of 20 general practices, ten single-handed and ten group practices using INR POCT, were randomly selected to participate in the study. Practice organisation and patient characteristics were recorded. INR measurements were collected retrospectively for a period of six months. For each patient, time in therapeutic range (TTR) was calculated and correlated with practice and patient characteristics using multilevel linear regression models. RESULTS: We identified 447 patients in warfarin treatment in the 20 practices using POCT (median = 19 patients; range: 6-55). The mean TTR for all patients was 69.3% (standard deviation (SD) = 24%), and for all practices the mean TTR was 67.3% (SD = 6.7%). The TTR in single-handed practices was lower than in group practices, 64.6% (SD = 8.0%) and 70.0% (SD = 3.6%), respectively; but the difference was not significant (4.2 percentage points (pp); 95% confidence interval (CI): -0.8-9.2). Short sampling intervals, e.g. 10-20 days (-11 pp; 95% CI: -16-6)) and lack of diagnostic coding (-11.8 pp; 95% CI: -19.9-3.7) were correlated with a low TTR. CONCLUSION: In our study most of the general practices using INR POCT in the management of patients in warfarin treatment provided good quality of care. Sampling interval and diagnostic coding were significantly correlated with treatment quality.

Psychological consequences of screening for cardiovascular risk factors in an un-selected general population: results from the Inter99 randomised intervention study.

BACKGROUND: Concerns that general health checks, including screening for risk factors to ischemic heart disease (IHD), have negative psychological consequences seem widely unfounded; however, previous studies are only based on self-reports from participants. AIM: To investigate if risk factor screening in healthy adults leads to mental distress in the study population, independent of participation. METHODS: The Inter99 study (1999 - 2006) was a randomised intervention in the general population, aiming to prevent IHD by a healthier lifestyle. We included the whole study population, independent of participation (n = 60,915). We merged data with information on the use of psychotropic medication and/or hospitalisation due to psychiatric diagnoses, as retrieved from national registers in Denmark, 4 years before and 5 years after the study began. We conducted analyses using generalised estimating equations. RESULTS: There was no significant difference between the intervention and control groups in their use of antipsychotics, hypnotics/sedatives, antidepressants or anxiolytics. As regards admission to the hospital with mental disorders, no significant difference was seen. These findings were true based on a yearly basis, and when investigating both short-term and a long-term effects of the intervention. There was no interaction with socioeconomic status. Of the 918 persons with a psychiatric diagnosis before the study start, 303 (33%) were re-admitted in the intervention period. Pre-screening of psychological status did not influence the psychological impact of screening. CONCLUSIONS: This large, randomised intervention study supports that screening for risk factors to IHD does not increase mental distress, not even in the mentally or socioeconomically most vulnerable persons. This study included the whole Inter99 study population not only study participants.