In British Columbia (BC), the distribution of radiology infrastructure is concentrated in large regional centers, which has created a problem of lack of proximal access to radiographic services in rural and remote areas. Although point-of-care ultrasound (PoCUS) is used in many rural Canadian emergency departments, a barrier to its greater use is the lack of health system infrastructure to support implementation, including limited training opportunities. Poor access to radiographic services in rural settings presents a challenge to timely diagnosis and screening across many disease states and healthy pregnancies. A solution to the lack of access to radiographic services in rural settings is the broader application of PoCUS by local general practitioners (GPs), enabled by increased access to training, subsidized ultrasound probes, and support provided by regional specialists.
To increase ultrasound capacity and use in rural BC communities, the Joint Standing Committee on Rural Issues has provided funding through the Rural Coordination Centre of BC (RCCBc) to support rural Family Physicians’ who want to include PoCUS in their clinical practice. With this funding, 50 rural GPs across BC have been issued ultrasound probes and training on the use of the probes. There are two parts to the PoCUS Evaluation. Phase I of this evaluation study investigates how PoCUS is being incorporated into rural GPs’ practice and its impacts on the delivery of care. Phase II of the study aims to interrogate the quality and utility of PoCUS by rural GPs.
Phase I – Objectives
Phase I of this study aims to explore how PoCUS is being used in rural BC communities. Specifically, the study aims to:
- Understand the experiences of participants in the IN PoCUS program (rural GPs using ultrasound probes and regional referral specialists providing ultrasound consultation); and
- Identify the scope of PoCUS practice and training for rural GP participants in the IN PoCUS program.
A qualitative study was conducted. In a virtual interview with 21 GPs across rural BC, participants were asked about their motivation to participate in RCCbc program, the type of training they received, their current use of PoCUS, their experience with the technology and their experience interacting with specialists in regional centres. Thematic analysis of findings was conducted.
Phase I – Key Findings
- The study found GPs recognized that the use of ultrasonography using PoCUS does not replace specialist imaging. Instead, GPs was the PoCUS as an extension of the physical exam.
- Physicians view many advantages to using PoCUS. PoCUS enabled better patient care. The real-time information physicians received from using PoCUS led to better decision-making, facilitated procedural care, and assisted in determining acuity of COVID-19. Physicians felt that their ability to improve patient care also led to an increased sense of job satisfaction.
- To support the use of PoCUS among rural GPs, larger system and policy needs to be put in place. A framework for billing structure, education, subsidized probes for rural providers and feedback on scans from specialists to ensure continuous quality improvement is needed.
If you have any questions about Phase I, please email Hilary Ho at firstname.lastname@example.org.
Phase II – Objectives
Phase II of the rural IN PoCUS evaluation study aims to understand the quality of ultrasound exams by rural GPs and the effect of exams on patient care. Study objectives are to:
- Assess whether PoCUS exams change GPs’ diagnostic confidence, and their patient care plans, and
- Understand the accuracy of low to moderate complexity PoCUS exams by GPs. The gold standard we will be using when assessing accuracy is imaging specialist interpretation of ultrasound images generated by GPs.
We are currently in the final planning stages of Phase II and will pilot the study protocol with GPs soon. If you have any questions about Phase I, please email Anshu Parajulee at email@example.com.