不列颠哥伦比亚省农村地区即时超声的使用：规模、培训和障碍。

Use of point-of-care ultrasound in rural British Columbia: Scale, training, and barriers.

机构信息

Family physician at the Haida Gwaii Health Centre in British Columbia and Clinical Assistant Professor in the Department of Family Practice at the University of British Columbia.

Clinical Associate Professor and Director of the Point of Care Ultrasound Fellowship program in the Department of Emergency Medicine at the University of British Columbia in Vancouver and an emergency medicine physician at Vancouver General Hospital.

出版信息

Can Fam Physician. 2024 Feb;70(2):109-116. doi: 10.46747/cfp.7002109.

DOI:10.46747/cfp.7002109

PMID:38383018

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11271830/

Abstract

OBJECTIVE

To determine the scale and scope of use of point-of-care ultrasound (POCUS) in rural British Columbia (BC).

DESIGN

Online survey.

SETTING

Rural BC.

PARTICIPANTS

Physicians practising in rural BC communities.

MAIN OUTCOME MEASURES

Practitioner demographic and practice characteristics, locations and frequency of POCUS use, POCUS education and training, and practitioner attitudes about and barriers to POCUS use.

RESULTS

Two hundred twenty-seven surveys were completed in fall 2021, corresponding to a response rate of 11.9% of all rural practitioners in BC. A total of 52.1% of respondents worked in communities with less than 10,000 people, while 24.9% had practices with relatively large proportions of Indigenous patients (more than 20% of the practice population). Respondents reported ease of access to local POCUS devices, with use highest in emergency departments (87.2%) followed by ambulatory care clinic (54.7%) and inpatient (50.3%) settings. Use of POCUS influenced clinical decision making in half the occasions in which it was employed, including a range of diagnostic and procedural applications. Barriers to use included lack of training, limited time to perform POCUS scans, and absence of image review or consultative support. Needed support for POCUS identified by respondents included real-time image acquisition advice and funding for both device acquisition and training. Recommendations for including POCUS training in undergraduate and residency education were strongly supported.

CONCLUSION

Use of POCUS in BC is expanding in frequency, scope, and scale in practices serving rural areas and in rural communities with large Indigenous populations, with practitioners reporting important improvements in clinical care as a result. Future research could help improve systemic support for POCUS use, guide needed curriculum changes in medical school and postgraduate training, and be used to inform continuing professional development needs.

摘要

目的

确定不列颠哥伦比亚省（BC）农村地区使用即时超声（POCUS）的规模和范围。

设计

在线调查。

地点

BC 农村地区。

参与者

在 BC 农村社区执业的医生。

主要观察指标

从业者的人口统计学和实践特征、POCUS 使用的地点和频率、POCUS 教育和培训以及从业者对 POCUS 使用的态度和障碍。

结果

2021 年秋季完成了 227 份调查，相当于 BC 所有农村从业者的 11.9%的回复率。52.1%的受访者在人口少于 10000 人的社区工作，而 24.9%的人在实践中有相对较多的原住民患者（超过实践人口的 20%）。受访者报告说，很容易获得当地的 POCUS 设备，使用率最高的是急诊科（87.2%），其次是门诊诊所（54.7%）和住院部（50.3%）。在使用 POCUS 的情况下，有一半影响了临床决策，包括一系列诊断和程序应用。使用 POCUS 的障碍包括缺乏培训、进行 POCUS 扫描的时间有限，以及缺乏图像审查或咨询支持。受访者需要支持 POCUS，包括实时图像采集建议以及设备采购和培训的资金。受访者强烈推荐将 POCUS 培训纳入本科和住院医师教育。