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 general practitioners (GPs) 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. The Centre for Rural Health Research at the University of British Columbia is evaluating this Intelligent Network for Point-of-Care Ultrasound (IN PoCUS) program. Phase I of the evaluation, which was qualitative, investigated how PoCUS is being incorporated into rural GPs’ practice and its impacts on the delivery of care. Phase II of the evaluation, which will be quantitative, aims to understand the quality and utility of PoCUS by rural GPs.
Phase I – Objectives
Phase I aimed to explore how PoCUS is being used in rural BC communities. Specifically, the study aimed 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.
Virtual interviews were conducted with 21 GPs across rural BC. GPs were asked about their motivation to participate in the IN PoCUS program, the type of training they received, their experience using PoCUS, and their experience interacting with specialists in regional centres.
Phase I – Key Findings
- GPs recognize that the use of ultrasonography using PoCUS does not replace specialist imaging. Instead, GPs use PoCUS as an extension of the physical exam.
- GPs reported many advantages to the use of PoCUS. The real-time information they receive from PoCUS leads to better decision-making, facilitates procedural care, and assists in determining the acuity of COVID-19. GPs thought that their ability to improve patient care led to an increased sense of job satisfaction.
- The following supports are needed for rural GPs using PoCUS: a PoCUS billing structure, improved access to PoCUS training and mentorship, subsidized ultrasound devices, and feedback on scans from specialists for quality assurance.
Click here for the report on Phase I findings.
Phase II – Objectives
Phase II aims to understand the quality of PoCUS by rural GPs and the effect of PoCUS use on patient care. Study objectives are to:
- Assess whether PoCUS changes GP diagnostic confidence, and their patient care plan (Table 1), and;
- Understand the accuracy of PoCUS by GPs, as measured by sensitivity and specificity, using imaging specialist interpretation as the gold standard.
A pre/post prospective cohort design will be used for Objective 1 and a cross-sectional design will be used for Objective 2.
We are recruiting rural GP study participants to Phase II. See the recruitment flyer here. If you have any questions about Phase II, please email Anshu Parajulee at firstname.lastname@example.org.