Cincinnati VA Medical Center, Medical Service, Cincinnati, OH, USA; Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA; New England Geriatric Research, Education, and Clinical Centers (GRECC), VA Boston Healthcare System, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
J Am Med Dir Assoc. 2024 Jun;25(6):104930. doi: 10.1016/j.jamda.2023.12.018. Epub 2024 Feb 6.
Older adults who are homebound and those in skilled nursing facilities (SNFs) often have limited access to point of care imaging to inform clinical decision making. Point-of-care ultrasonography (POCUS) can help span this gap by augmenting the physical examination to aid in diagnosis and triaging. Although training in POCUS for medical trainees is becoming more common and may focus on settings such as the emergency department, intensive care unit, and inpatient care, little is known about POCUS training among practicing clinicians who work outside of these settings. We conducted a national needs assessment survey around experience with POCUS focused on practicing clinicians in the sub-acute, long-term, and home-based care settings in the Veterans Affairs (VA) health system.
An electronic survey was developed and sent out to clinicians via Listservs for the VA long-term and sub-acute care facilities [Community Living Centers (CLCs)], Home Based Primary Care outpatient teams, and Hospital in Home teams to assess current attitudes, previous training, and skills related to POCUS.
Eighty-eight participants responded to the survey, for an overall response rate of 29% based on the number of emails on each Listserv, representing CLC, home-based primary care, and hospital in home. Sixty percent of clinicians reported no experience with POCUS, and 76% reported that POCUS and POCUS training would be useful to their practice. More than 50% cited lack of training and lack of equipment as 2 significant barriers to POCUS use.
This national needs assessment survey of VA clinicians reveals important opportunities for training in POCUS for clinicians working with older adults who are receiving home care homebound or living in SNFs.
行动不便的老年患者和长期护理机构（SNF）中的患者通常无法获得即时护理成像来辅助临床决策。即时护理超声（POCUS）可以通过增强体格检查来辅助诊断和分诊，从而弥补这一差距。尽管医学实习生的 POCUS 培训越来越普遍，并且可能集中在急诊科、重症监护室和住院护理等环境中，但在这些环境之外工作的执业临床医生中，关于 POCUS 培训的了解甚少。我们对退伍军人事务部（VA）医疗系统中亚急性、长期和家庭护理环境中的执业临床医生进行了一项以 POCUS 为重点的全国需求评估调查。
通过 VA 长期和亚急性护理设施（社区生活中心（CLC））、家庭为基础的初级保健门诊团队和家庭医院团队的 List-serv 向临床医生发送了一份电子调查，以评估他们在 POCUS 方面的当前态度、先前的培训和技能。
共有 88 名参与者对调查做出了回应，根据每个 List-serv 的电子邮件数量，总体回应率为 29%，代表 CLC、家庭为基础的初级保健和家庭医院。60%的临床医生报告没有使用过 POCUS，76%的临床医生报告 POCUS 和 POCUS 培训对他们的实践有用。超过 50%的人表示缺乏培训和设备是使用 POCUS 的两个重要障碍。
这项针对 VA 临床医生的全国需求评估调查揭示了为接受家庭护理、行动不便或居住在 SNF 的老年患者提供服务的临床医生提供 POCUS 培训的重要机会。
