Pocus in practice
– Implementation of point-of-care ultrasound in Danish general practice: a stepped-wedge cluster randomized study
The increasing life expectancy leads to more patients with multimorbidity and complex disease processes. At the same time, the secondary sector is being centralized and subspecialised. This increases the demands on the general practitioner in terms of correct diagnostics and visitation. The Danish Health Authority’s new national strategy for research in the primary healthcare system recommends that research be strengthened within the clinical investigation in general practice as well as within the development of complex interventions and their implementation.
In the collective agreement between the health authorities and general practice (OK-22), the parties have initiated a research project to investigate if ultrasound in general practice can contribute to improved diagnostics, timely referrals, and increased quality in clinical decision making. The research project is developed and implemented in accordance with the Medical Research Council’s recommendations for complex interventions in medical research.
The project includes two pilot studies and a main study as well as an ongoing process evaluation.
In the first pilot study, 18 general practitioners are included to investigate whether
- GPs can be trained to obtain scanning competence , and
- whether the scanning competences can be maintained over time.
In the next pilot study, 34 general practitioners are included to assess:
- the frequency of ultrasound scans in general practice,
- how the use of ultrasound for different clinical conditions develops over time, and
- the GPs’ experienced diagnostic value of different ultrasound examinations
Finally, in the main study 200 general practitioners will be included to investigate the effects of introducing ultrasound by comparing the following parameters before and after ultrasound is introduced as to:
- whether the general practitioners will adopt the technology and continue using ultrasound in general practice,
- how the use of ultrasound scanning in general practice affect the number of referrals to the secondary sector,
- how the introduction of ultrasound will affect GP job satisfaction, feelings of stress and burnout,
- how patients experience the use of ultrasound scanning in general practice,
- how the number of consultations in general practice are affected.
Finally, an analysis of the consequences of introducing ultrasound in the practices on key health economic parameters will be performed.
During the research project, we will continually evaluate the process and the results according to contextual factors, financial considerations, and points of uncertainty. We will develop and re-define the program theory behind the intervention, the study design, and our educational intervention, and we will involve a follow-up group of stakeholders and participants in this evaluation.
Data will be collected as registrations during the course, evaluation of scanning competency, log book registration of scanning activity in general practice, re-imbursement codes, questionnaires and focus group interviews. Collection of data and storage of data will follow the Danish Data Protection Authority’s regulations. Reporting will follow international guidelines and emphasis will be placed on communicating both positive and negative results from the research project.
Camilla Aakjær, MD, Ph.d., Lecturer, Research Unit for General Practice, Aalborg University