Flynn Candi J, Weppler Alison, Theodoro Daniel, Haney Elizabeth, Milne W Ken
Faculty of Medicine, University of Toronto, Toronto, Ont., Canada.
Can J Rural Med. 2012 Summer;17(3):99-104.
The Canadian Association of Emergency Physicians (CAEP) published a position statement in 2006 encouraging immediate access to emergency medicine ultrasonography (EMUS) 24 hours a day, 7 days a week. However, barriers to advanced imaging care still exist in many rural hospitals. Our study investigated the current availability of EMUS in rural communities and physicians' ability to use this technology.
A literature review and interviews with rural physicians were conducted in the summer of 2010 to design a questionnaire focusing on EMUS. The survey was then sent electronically or via regular mail in November 2010 to all Ontario physicians self-identified as "rural." Descriptive statistics and the Fisher exact test were used to analyze the data.
A total of 207 rural physicians responded to the survey (response rate 28.6%). Of the respondents, 70.9% were male, median age was 49 years and median year of graduation was 1988. The respondents had been in practice for a median of 20 years and had been in their present community for a median of 15 years. More than two-thirds of physicians (69.5%) practised in communities with populations of less than 10 000. Nearly three-quarters (72.6%) worked in a rural emergency department (ED). Almost all (96.9%) reported having access to ultrasonography in the hospital. However, only 60.6% had access to ultrasonography in the ED. Less than half (44.4%) knew how to perform ultrasonography, with 77.3% citing lack of training. Of those using EMUS, 32.5% were using it at least once per shift. The most common reason to use EMUS was to rule out abdominal aortic aneurysm (58.3%). Most respondents (71.5%) agreed or strongly agreed that EMUS is a skill that all rural ED physicians should have.
Patients in many rural EDs do not have immediate access to EMUS, as advocated by CAEP. This gap in care needs to be addressed to ensure that all patients, no matter where they live, have access to this proven imaging modality.
加拿大急诊医师协会（CAEP）于2006年发表了一份立场声明，鼓励每周7天、每天24小时即时获取急诊医学超声检查（EMUS）。然而，许多农村医院在先进影像检查方面仍存在障碍。我们的研究调查了农村社区EMUS的当前可及性以及医生使用该技术的能力。
2010年夏季进行了文献综述并对农村医生进行了访谈，以设计一份聚焦于EMUS的问卷。然后在2010年11月通过电子邮件或普通邮件将调查问卷发送给所有自认为是“农村”的安大略省医生。使用描述性统计和Fisher精确检验来分析数据。
共有207名农村医生回复了调查（回复率28.6%）。在受访者中，70.9%为男性，年龄中位数为49岁，毕业年份中位数为1988年。受访者的执业时间中位数为20年，在当前社区的时间中位数为15年。超过三分之二的医生（69.5%）在人口不足10000的社区执业。近四分之三（72.6%）在农村急诊科（ED）工作。几乎所有（96.9%）报告称医院可进行超声检查。然而，只有60.6%的人在急诊科可进行超声检查。不到一半（44.4%）的人知道如何进行超声检查，77.3%的人表示缺乏培训。在使用EMUS的人中，32.5%每班至少使用一次。使用EMUS最常见的原因是排除腹主动脉瘤（58.3%）。大多数受访者（71.5%）同意或强烈同意EMUS是所有农村急诊科医生都应具备的技能。
正如CAEP所倡导的，许多农村急诊科的患者无法即时获得EMUS检查。需要解决这种护理差距，以确保所有患者，无论居住在哪里，都能获得这种经过验证的影像检查方式。
