瑞士初级保健医生使用诊断超声的情况 - 一项横断面研究。
The use of diagnostic ultrasound by primary care physicians in Switzerland - a cross-sectional study.
机构信息
Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
Center for Primary and Community Care, University of Lucerne, Lucerne, Switzerland.
出版信息
BMC Prim Care. 2024 Jul 6;25(1):246. doi: 10.1186/s12875-024-02491-5.
BACKGROUND
Diagnostic ultrasound has become a bedside tool widely available to many primary care physicians (PCPs) in Europe. It is often used as point-of-care ultrasonography (POCUS) in this setting. In Switzerland, certain POCUS examinations are listed as learning objectives in existing ultrasound training programs (we defined these examinations as swissPOCUS = sPOCUS). Ultrasound performed by PCPs can lead to faster diagnostic workup and reduce referral to secondary care units. However, adequate training is crucial to guarantee high quality. To guide the development of ultrasound training programs for PCPs, this study explores the use of ultrasound in primary care in Switzerland.
METHODS
This was a cross-sectional study. We invited PCPs from the Swiss practice-based research network "Sentinella" to collect data on the first 5 daily ultrasounds they ordered or performed themselves. Participating PCPs collected data for 3 months - divided into 4 groups to account for seasonal differences.
RESULTS
Out of 188 PCPs invited, 81.9% provided data through an initial questionnaire. 46.8% provided data on 1616 ultrasounds. 56.5% of PCPs had access to ultrasound machines, while 29.8% had completed formal training. 77% of the reported ultrasounds were self-performed; 27% of the reported scans (35% of all self-performed scans) were performed by PCPs with incomplete or no formal training. The main areas of interest were the abdominal (57.9%) and the musculoskeletal (22%) region. 36.9% of reported examinations were sPOCUS exams. Among PCPs with access to US machines, the percentages of referred examinations were similar for sPOCUS (11.9%) and non-sPOCUS (11.3%) indications. However, some sPOCUS musculoskeletal ultrasounds were often referred (e.g. tendon/ligament/muscle injuries or cutaneous/subcutaneous tumour).
CONCLUSION
Most Swiss PCPs had access to ultrasound equipment and performed a majority of both sPOCUS and non-sPOCUS scans themselves, often without or with incomplete training. This reflects the fact that POCUS was only recently introduced in Switzerland. There is a need for easily accessible POCUS training programs aimed at PCPs in Switzerland. Training courses for PCPs should focus on abdominal and musculoskeletal ultrasound, because these were the most common sites for scans, and because some sPOCUS musculoskeletal examinations showed a particularly high percentage of referral.
背景
诊断超声已成为欧洲许多初级保健医生（PCP）广泛使用的床边工具。在这种情况下，它通常被用作即时超声检查（POCUS）。在瑞士，某些 POCUS 检查被列为现有超声培训计划的学习目标（我们将这些检查定义为 swissPOCUS= sPOCUS）。PCP 进行的超声检查可以加快诊断过程，并减少向二级保健单位转介。然而，充分的培训对于保证高质量至关重要。为了指导 PCP 超声培训计划的发展，本研究探讨了瑞士初级保健中超声的使用情况。
方法
这是一项横断面研究。我们邀请了瑞士基于实践的研究网络“Sentinella”的 PCP 参与，要求他们收集自己首次开具或执行的 5 份日常超声检查的资料。参与的 PCP 在 3 个月内分 4 组进行数据收集，以考虑季节性差异。
结果
在受邀的 188 名 PCP 中，81.9% 通过初始问卷提供了数据。46.8%提供了 1616 份超声检查的数据。56.5%的 PCP 可以使用超声设备，而 29.8%的 PCP 完成了正规培训。77%的报告超声由 PCP 自行执行；27%的报告扫描（自我执行扫描的 35%）由未经完整或无正规培训的 PCP 执行。主要关注的领域是腹部（57.9%）和肌肉骨骼（22%）区域。36.9%的报告检查为 sPOCUS 检查。在可以使用 US 机器的 PCP 中，sPOCUS（11.9%）和非 sPOCUS（11.3%）指征的转诊检查百分比相似。然而，一些 sPOCUS 肌肉骨骼超声检查经常被转诊（例如，肌腱/韧带/肌肉损伤或皮肤/皮下肿瘤）。
结论
大多数瑞士 PCP 可以使用超声设备，并且自行执行大多数 sPOCUS 和非 sPOCUS 扫描，通常没有或仅有不完整的培训。这反映了 POCUS 最近才在瑞士引入的事实。瑞士需要易于获得的针对 PCP 的 POCUS 培训计划。针对 PCP 的培训课程应侧重于腹部和肌肉骨骼超声，因为这些是扫描最常见的部位，并且一些 sPOCUS 肌肉骨骼检查显示出特别高的转诊百分比。
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