Abrokwa Seth Kofi, Ruby Lisa C, Heuvelings Charlotte C, Bélard Sabine
Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Germany.
Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
EClinicalMedicine. 2022 Mar 6;45:101333. doi: 10.1016/j.eclinm.2022.101333. eCollection 2022 Mar.
Low-and middle-income countries (LMIC) are faced with healthcare challenges including lack of specialized healthcare workforce and limited diagnostic infrastructure. Task shifting for point-of-care ultrasound (POCUS) can overcome both shortcomings. This review aimed at identifying benefits and challenges of task shifting for POCUS in primary healthcare settings in LMIC. Medline and Embase were searched up to November 22nd, 2021. Publications reporting original data on POCUS performed by local ultrasound naïve healthcare providers in any medical field at primary healthcare were included. Data were analyzed descriptively. PROSPERO registration number CRD42021223302. Overall, 36 publications were included, most ( = 35) were prospective observational studies. Medical fields of POCUS application included obstetrics, gynecology, emergency medicine, infectious diseases, and cardiac, abdominal, and pulmonary conditions. POCUS was performed by midwives, nurses, clinical officers, physicians, technicians, and community health workers following varying periods of short-term training and using different ultrasound devices. Benefits of POCUS were yields of diagnostic images with adequate interpretation impacting patient management and outcome. High cost of face-to-face training, poor internet connectivity hindering telemedicine components, and unstable electrici'ty were among reported drawbacks for successful implementation of task shifting POCUS. At the primary care level in resource-limited settings task shifting for POCUS has the potential to expand diagnostic imaging capacity and impact patient management leading to meaningful health outcomes.
低收入和中等收入国家（LMIC）面临着医疗保健挑战，包括缺乏专业医疗保健人员以及诊断基础设施有限。即时超声检查（POCUS）的任务转移可以克服这两个缺点。本综述旨在确定在低收入和中等收入国家的初级医疗保健环境中进行POCUS任务转移的益处和挑战。检索了截至2021年11月22日的Medline和Embase数据库。纳入了报告由初级医疗保健机构中任何医学领域的当地超声新手医疗保健提供者进行的POCUS原始数据的出版物。对数据进行了描述性分析。PROSPERO注册号为CRD42021223302。总体而言，纳入了36篇出版物，其中大多数（n = 35）是前瞻性观察性研究。POCUS的应用医学领域包括产科、妇科、急诊医学、传染病以及心脏、腹部和肺部疾病。POCUS由助产士、护士、临床干事、医生、技术人员和社区卫生工作者进行，他们接受了不同时期的短期培训并使用不同的超声设备。POCUS的益处是产生具有充分解读的诊断图像，影响患者管理和预后。报告的成功实施POCUS任务转移的缺点包括面对面培训成本高、互联网连接差阻碍远程医疗组件以及电力不稳定。在资源有限的环境中的初级保健层面，POCUS的任务转移有可能扩大诊断成像能力并影响患者管理，从而带来有意义的健康结果。
