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Current use of Point-of-Care (POC) Ultrasound in the Family Medicine Setting<br />
Vogt, C.T., D.O.; Manyan, J. D.O.<br />
Kent Hospital, Family Medicine Residency, Warwick, RI.<br />
Introduction: In the past 10 years, the utility and benefits of point of care (POC) ultrasound have been<br />
thoroughly documented and studied in the emergency, anesthesia, obstetrics and intensive care settings.<br />
The clinical utility of POC ultrasound has been identified for diagnosis and screening in trauma, renal,<br />
biliary, aortic, cardiac, pulmonary and gynecological/obstetrical complaints. As a result, ultrasound<br />
techniques and competencies have been added to the curriculum in all of these residency programs.<br />
Currently only a minority of FM residency programs include POC ultrasound in their standard educational<br />
curriculum. The University Of Minnesota and University of South Carolina both have a strong ultrasound<br />
component to their family medicine residency programs. This might partly be due to the rural based<br />
practice setting that residents are transitioning into after residency. As the field of POC ultrasound<br />
expands, ultrasound education at medical schools is on the rise. This project was developed in order to<br />
determine the current use of POC ultrasound in the family medicine (FM) setting.<br />
Methods: This literature review started with a PudMed search combining FM/primary care/general<br />
practice (GP)/office with bedside/POC ultrasound. The search was limited to institutional full text<br />
availability, and publication dates back to 2002.<br />
Results: Research in POC ultrasound in the FM setting is limited compared to the other commonly<br />
accepted application settings, ie. emergency medicine and anesthesia. The multiple combined searches<br />
resulted in over one-thousand articles. Article titles were then reviewed for inclusion of the above key<br />
words. Ten articles were selected for review; the articles were focused on abdominal (3), cardiac (1),<br />
breast (1), musculoskeletal (2) and educational/usage trends (3). Six of the ten articles were from<br />
international sources.<br />
Conclusions: The ten articles reviewed provided a snap shot of the current utilization of POC ultrasound<br />
in the FM setting and its effect on patient outcomes. One study showed anticipated patient management<br />
by the GP changed in 64% of patients following upper abdominal ultrasound in the office setting. POC<br />
abdominal ultrasound substantially reduced the number of intended referrals to a medical specialist, and<br />
more patients could be reassured by their GP. With limited training GPs were able to rule out or exclude<br />
fluid collections, aortic aneurysm and common gallbladder disease. An office based ultrasound study<br />
showed abdominal aortic aneurysm screening can be safely performed in the office by family physicians<br />
who are trained to use POC ultrasound technology. The screening test can be completed within the time<br />
constraints of a busy family practice office visit. Breast ultrasound imaging by GPs was preferred over<br />
mammography for image guided intervention such as biopsy and localization. GPs identified ultrasound<br />
as the breast imaging test of choice for young women and women who are pregnant or lactating. The<br />
articles demonstrate there are many different types of clinical scenarios where utilization of POC<br />
ultrasound in the FM setting can improve the patient experience and outcome. Office based ultrasound<br />
was shown to reduce the need for radiographic studies thus reducing the patient’s life time radiation<br />
exposure. A particularly promising development in the care of sports injuries is the expansion of injection<br />
therapies, and in-office ultrasound provides assurance that prolotherapy, platelet-rich plasma, dry<br />
needling, corticosteroid, and viscosupplementation are delivered accurately and safely. As studies<br />
continue to validate ultrasound's effectiveness in diagnosing injuries to the upper and lower extremities<br />
compared with more costly magnetic resonance imaging and more invasive exploratory surgery, its<br />
promise as a cost-effective diagnostic tool is growing. However the paucity of articles found on the topic<br />
clearly shows a need for further review. Even when noncardiac POC ultrasound by nonradiologist<br />
physicians was found to be increased by 11% in the primary care setting another review article of POC<br />
ultrasound utilization failed to name primary care on their list of specialties using POC ultrasound.<br />
Further research is needed to validate the utility of the broad spectrum of POC ultrasound usage in the<br />
family medicine setting.