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5. General Practitioners' Perspectives on Appropriate Use of Ultrasonography in Primary Care in Denmark: A Multistage Mixed Methods Study

Author

Andersen, Camilla Aakjaer, Guetterman, Timothy C., Fetters, Michael D., Brodersen, John, Davidsen, Annette Sofie, Graumann, Ole, and Jensen, Martin Bach

Subjects
Diagnosis, Ultrasonic -- Surveys -- Usage, Primary health care -- Surveys -- Methods, Physicians (General practice) -- Surveys, Health, Science and technology
Abstract

PURPOSE Researchers aimed to describe general practitioners' understanding of appropriate ultrasound use, to record actual scanning practices of early adopters in general practice, and to identify differences between attitudes and actual practice via a mixed methods analysis. METHODS This study was part of a larger multistage mixed methods research framework exploring the use of ultrasound in general practice in Denmark. We used an exploratory sequential approach in the data collection with initial qualitative findings from an interview study applied to building a quantitative questionnaire utilized in a cohort study. In addition, we merged the qualitative and quantitative data using joint display analysis to compare and contrast the results from the 2 stages of the study. RESULTS In the interviews, general practitioners described appropriate ultrasound use as point-of-care examinations with a clear purpose and limited to predefined specific conditions within delimited anatomic areas. They stated that general practitioners should receive formalized ultrasound training and be skilled in the examinations they perform. In the cohort study, general practitioners performed ultrasound examinations of anatomic areas with or without a defined clinical suspicion. Some performed ultrasound examinations for which they had no previous training or skills. CONCLUSIONS We found a difference between the ideas about the appropriate uses for ultrasound in general practice and the actual use by early adopters in clinical practice. Our findings suggest a need for evidence-based guidelines to support general practitioners in choosing which examinations to perform and strategies for developing and maintaining scanning competency. Key words: family practice, general practice, primary health care, point-of-care systems, ultrasonography Ann Fam Med 2022;20:211-219. https://doi.org/10.1370/afm.2795, INTRODUCTION Point-of-care ultrasonography (POCUS) is performed by a frontline clinician and integrated into the examination of the patient. (1) Despite lack of evidence-based guidelines, POCUS use is growing in general [...]

Published
2022
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11. Structured POCUS education for primary care physicians: the transition from short workshops to sustainable longitudinal learning.

Author

Andersen, Camilla Aakjær and Jensen, Martin Bach

Subjects
*PRIMARY care, *LEARNING, *ONLINE education, *EDUCATIONAL support, *APPROPRIATE technology
Abstract

The use of point-of-care ultrasonography in primary care is increasing. Primary care physicians are introduced to ultrasonography at short workshops with little guidance for implementation of the technology in clinical routines and medical decision-making. This article introduces a framework for longitudinal ultrasound education tailored for office-based general practice, building on the best available evidence and established teaching principles. The framework includes three teaching seminars over three months, a curriculum of 10 ultrasound applications, an online learning platform providing educational support before, during, and after the teaching seminars and continuous support and feedback from allocated mentors. The framework aims to reduce primary care physicians’ absence from the clinic, scaffold the learning process to build a solid and sustainable foundation of knowledge, and support implementation and appropriate use of the technology in the unselected patient population in primary care setting. Evaluation of the framework demonstrated high satisfaction with the educational elements among both participants and teachers. [ABSTRACT FROM AUTHOR]

Published
2024
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12. Exploring general practice staff perspectives on a teaching concept based on instruction videos for diabetic retinopathy screening – an interview study.

Author

Krogh, Malene, Jensen, Martin Bach, Sig Ager Jensen, Morten, Hentze Hansen, Malene, Germund Nielsen, Marie, Vorum, Henrik, and Kristensen, Jette Kolding

Subjects
*TYPE 2 diabetes, *LEARNING curve, *CONCEPT learning, *DIABETIC retinopathy, *ARTIFICIAL intelligence
Abstract

AbstractObjectiveDesign and settingMethodResultsConclusionThe aim of this study is to explore general practice staff perspectives regarding a teaching concept based on instructional videos for conducting DR screenings. Furthermore, this study aims to investigate the competencies acquired by the staff through this teaching concept.Qualitative cross-sectional study conducted in general practice clinics in the North Denmark Region.A teaching concept was developed based on instruction videos to teach general practice staff to conduct diabetic retinopathy screenings with automated grading through artificial intelligence. Semi-structured interviews were performed with 16 staff members to investigate their perspectives on the concept and acquired competencies.This study found no substantial resistance to the teaching concept from staff; however, participants’ satisfaction with the methods employed in the instruction session, the progression of learning curves, screening competencies, and their acceptance of a known knowledge gap during screenings varied slightly among the participants.This study showed that the teaching concept can be used to teach general practice staff to conduct diabetic retinopathy screenings. Staffs’ perspectives on the teaching concept and acquired competencies varied, and this study suggest few adjustments to the concept to accommodate staff’s preferences and establish more consistent competencies. [ABSTRACT FROM AUTHOR]

Published
2024
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20. Point-of-Care Ultrasound in General Practice: A Systematic Review

Author

Andersen, Camilla Aakjar, Holden, Sinead, Vela, Jonathan, Rathleff, Michael Skovdal, and Jensen, Martin Bach

Subjects
Usage, Methods, Training, Diagnostic ultrasonography -- Usage -- Methods, General practitioners -- Training -- Methods -- Usage, Primary health care -- Methods -- Usage
Abstract

INTRODUCTION Point-of-care ultrasound (POCUS) is described as the stethoscope of the future (1) and is being implemented across the medical field by clinicians for bedside examination of patients. (1-3) Evidence [...], PURPOSE Ultrasound examinations are currently being implemented in general practice. This study aimed to systematically review the literature on the training in and use of point-of-care ultrasound (POCUS) by general practitioners. METHODS We followed the Cochrane guidelines for conduct and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting. We searched the databases MEDLINE (via PubMed), EMBASE, CINAHL, Web of Science, and Cochrane Central Register of Controlled Trials using the key words ultrasonography and general practice in combination and using thesaurus terms. Two reviewers independently screened articles for inclusion, extracted data, and assessed the quality of included studies using an established checklist. RESULTS We included in our review a total of 51 full-text articles. POCUS was applied for a variety of purposes, with the majority of scans focused on abdominal and obstetric indications. The length of training programs varied from 2 to 320 hours. Competence in some types of focused ultrasound scans could be attained with only few hours of training. Focused POCUS scans were reported to have a higher diagnostic accuracy and be associated with less harm than more comprehensive scans or screening scans. The included studies were of a low quality, however, mainly because of issues with design and reporting. CONCLUSIONS POCUS has the potential to be an important tool for the general practitioner and may possibly reduce health care costs. Future research should aim to assess the quality of ultrasound scans in broader groups of general practitioners, further explore how these clinicians should be trained, and evaluate the clinical course of patients who undergo scanning by general practitioners. Key words: ultrasonography; diagnostic imaging; screening; general practice; point-of-care testing; primary care; practice-based research

Published
2019
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27. Factors affecting point-of-care ultrasound implementation in general practice:a survey in Danish primary care clinics

Author

Andersen, Camilla Aakjær, Brodersen, John Brandt, Graumann, Ole, Davidsen, Annette Sofie, Jensen, Martin Bach, Andersen, Camilla Aakjær, Brodersen, John Brandt, Graumann, Ole, Davidsen, Annette Sofie, and Jensen, Martin Bach

Abstract

Objective The implementation of point-of-care ultrasound (POCUS) in general practice varies, but it is unknown what determines this variation. The purpose of this study was to explore (1) the overall proportion of POCUS-users among general practitioners (GPs), (2) the current use of POCUS by GPs, (3) factors related to the implementation of POCUS in general practice and (4) GPs’ concerns related to POCUS use in general practice. Design An online survey was distributed in June 2019. Setting General practice. Participants GPs working in office-based primary care clinics in Denmark. Main outcome measures The questionnaire was developed using mixed methods and included questions about participants’ characteristics, past POCUS training and experience, capability, opportunity and motivation for using POCUS in the primary care setting. Results were summarised using descriptive statistics. Association between GPs’ background characteristics and POCUS use was tested using logistics regression. Results Responses were analysed from 1216 questionnaires corresponding to 36.4% of all GPs in Denmark. The majority (72.3%) of participants had previous POCUS experience, 14.7% had access to a POCUS device and 11.5% used POCUS. Several factors motivated participants to use POCUS. However, barriers existed such as lack of remuneration and high workload. Additionally, many GPs questioned their ability to scan with sufficient diagnostic accuracy and the impact of POCUS on the consultation. Of non-users, 28.7% believed they would be using POCUS in the future. Conclusion Although, the majority of GPs had past experience with POCUS and felt motivated to use it, few had implemented POCUS. Several factors influenced the GPs’ capability, opportunity and motivation for using POCUS and several concerns were registered by non-users., OBJECTIVE: The implementation of point-of-care ultrasound (POCUS) in general practice varies, but it is unknown what determines this variation. The purpose of this study was to explore (1) the overall proportion of POCUS-users among general practitioners (GPs), (2) the current use of POCUS by GPs, (3) factors related to the implementation of POCUS in general practice and (4) GPs' concerns related to POCUS use in general practice.DESIGN: An online survey was distributed in June 2019.SETTING: General practice.PARTICIPANTS: GPs working in office-based primary care clinics in Denmark.MAIN OUTCOME MEASURES: The questionnaire was developed using mixed methods and included questions about participants' characteristics, past POCUS training and experience, capability, opportunity and motivation for using POCUS in the primary care setting. Results were summarised using descriptive statistics. Association between GPs' background characteristics and POCUS use was tested using logistics regression.RESULTS: Responses were analysed from 1216 questionnaires corresponding to 36.4% of all GPs in Denmark. The majority (72.3%) of participants had previous POCUS experience, 14.7% had access to a POCUS device and 11.5% used POCUS. Several factors motivated participants to use POCUS. However, barriers existed such as lack of remuneration and high workload. Additionally, many GPs questioned their ability to scan with sufficient diagnostic accuracy and the impact of POCUS on the consultation. Of non-users, 28.7% believed they would be using POCUS in the future.CONCLUSION: Although, the majority of GPs had past experience with POCUS and felt motivated to use it, few had implemented POCUS. Several factors influenced the GPs' capability, opportunity and motivation for using POCUS and several concerns were registered by non-users.

Published
2023

28. National clinical guidelines for non-surgical treatment of patients with recent onset neck pain or cervical radiculopathy

Author

Kjaer, Per, Kongsted, Alice, Hartvigsen, Jan, Isenberg-Jørgensen, Alexander, Schiøttz-Christensen, Berit, Søborg, Bolette, Krog, Charlotte, Møller, Christian Martin, Halling, Christine Marie Bækø, Lauridsen, Henrik Hein, Hansen, Inge Ris, Nørregaard, Jesper, Jørgensen, Karsten Juhl, Hansen, Lars Valentin, Jakobsen, Marie, Jensen, Martin Bach, Melbye, Martin, Duel, Peter, Christensen, Steffan W., and Povlsen, Tina Myung

Published
2017
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29. National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy

Author

Stochkendahl, Mette Jensen, Kjaer, Per, Hartvigsen, Jan, Kongsted, Alice, Aaboe, Jens, Andersen, Margrethe, Andersen, Mikkel Ø., Fournier, Gilles, Højgaard, Betina, Jensen, Martin Bach, Jensen, Lone Donbæk, Karbo, Ture, Kirkeskov, Lilli, Melbye, Martin, Morsel-Carlsen, Lone, Nordsteen, Jan, Palsson, Thorvaldur Skuli, Rasti, Zoreh, Silbye, Peter Frost, Steiness, Morten Zebitz, Tarp, Simon, and Vaagholt, Morten

Published
2017
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30. Development of a clinical decision-support tool for Management of Adolescent knee Pain (The MAP-Knee Tool)

Author

Riel, Henrik, Bruun, Malene Kjær, Djurtoft, Chris, Jensen, Martin Bach, Kaalund, Søren, Leeuwen, Guido van, Overgaard, Charlotte, Rahbek, Ole, and Rathleff, Michael Skovdal

Subjects
rehabilitation medicine and physical therapy
Abstract

Objective This study aimed to develop a clinical decision-support tool (The MAP-Knee Tool) to improve the management of adolescents with non-traumatic knee pain.Methods This multi-step study consisted of five steps ((1-4) initial development and (5) end-user testing with adolescents with or without non-traumatic knee pain and medical doctors). It ended with the first version of the MAP-Knee Tool for the six most common non-traumatic knee pain conditions. The tool includes four components: 1) tool for diagnosing, 2) credible explanations of the diagnoses based on two systematic literature searches and an Argumentative Delphi process with international experts, 3) prognostic factors based on an individual participant data meta-analysis, and 4) option grid including an unbiased presentation of management options based on the available evidence.Results We included seven children/adolescents (8-15 years old) and seven medical doctors for the end-user testing. All four components were revised accordingly, and the text was condensed as the initial draft was too comprehensive.Conclusion We developed a clinical decision-support tool for clinicians and adolescents with non-traumatic knee pain to support the consultation in clinical practice. ObjectiveThis study aimed to develop a clinical decision-support tool (The MAP-Knee Tool) to improve the management of adolescents with non-traumatic knee pain. MethodsThis multi-step study consisted of five steps ((1-4) initial development and (5) end-user testing with adolescents with or without non-traumatic knee pain and medical doctors). It ended with the first version of the MAP-Knee Tool for the six most common non-traumatic knee pain conditions. The tool includes four components: 1) tool for diagnosing, 2) credible explanations of the diagnoses based on two systematic literature searches and an Argumentative Delphi process with international experts, 3) prognostic factors based on an individual participant data meta-analysis, and 4) option grid including an unbiased presentation of management options based on the available evidence. ResultsWe included seven children/adolescents (8-15 years old) and seven medical doctors for the end-user testing. All four components were revised accordingly, and the text was condensed as the initial draft was too comprehensive. ConclusionWe developed a clinical decision-support tool for clinicians and adolescents with non-traumatic knee pain to support the consultation in clinical practice. Practice ImplicationsThe tool targets clinicians and adolescents with four components that may decrease diagnostic uncertainty and increase shared decision-making.

Published
2023
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37. Learning strategies of general practitioners striving to achieve point-of-care ultrasound competence:a qualitative study

Author

Andersen, Camilla Aakjær, Espersen, Marie, Brodersen, John, Thomsen, Janus Laust, Jensen, Martin Bach, Davidsen, Annette Sofie, Andersen, Camilla Aakjær, Espersen, Marie, Brodersen, John, Thomsen, Janus Laust, Jensen, Martin Bach, and Davidsen, Annette Sofie

Abstract

Background Point-of-care ultrasonography (POCUS) is increasingly used in general practice despite the lack of official educational programmes or guidelines for general practitioners (GPs). Aim To explore how GPs have learnt to use POCUS and which barriers they have encountered in their learning process. Design and setting Qualitative study conducted in office-based general practice in Denmark. Methods Semi-structured interviews were conducted with 13 GPs who had implemented POCUS without supporting guidelines or regulations. Analysis was carried out using systematic text condensation. The interview data for this study were collected along with data used in a previous study. Results The participating GPs described having composed their own ultrasound education following a continuous learning process. Basic POCUS competences were achieved through formalized training sessions at hospital departments or courses. The GPs further developed and expanded their scanning skills through additional courses and continuous self-study practice on patients often while consulting internet sources, textbooks or colleagues. Lack of available ultrasound courses, supervision, and clinical guidelines together with time constraints and financial aspects were mentioned as barriers to their ultrasound training. Conclusion This study showed how GPs had composed their own ultrasound education individually and differently, guided by their own experiences and beliefs about good clinical practice. Formalized ultrasound training was considered a prerequisite for achieving basic ultrasound competences while continuous practice was considered paramount to develop and maintain scanning skills. There were several obstacles to overcome in the learning process including lack of supervision, guidance, and opportunity for practicing skills.

Published
2022

38. General Practitioners' Perspectives on Appropriate Use of Ultrasonography in Primary Care in Denmark:A Multistage Mixed Methods Study

Author

Andersen, Camilla Aakjær, Guetterman, Timothy C, Fetters, Michael D, Brodersen, John, Davidsen, Annette Sofie, Graumann, Ole, Jensen, Martin Bach, Andersen, Camilla Aakjær, Guetterman, Timothy C, Fetters, Michael D, Brodersen, John, Davidsen, Annette Sofie, Graumann, Ole, and Jensen, Martin Bach

Abstract

PURPOSE: Researchers aimed to describe general practitioners' understanding of appropriate ultrasound use, to record actual scanning practices of early adopters in general practice, and to identify differences between attitudes and actual practice via a mixed methods analysis.METHODS: This study was part of a larger multistage mixed methods research framework exploring the use of ultrasound in general practice in Denmark. We used an exploratory sequential approach in the data collection with initial qualitative findings from an interview study applied to building a quantitative questionnaire utilized in a cohort study. In addition, we merged the qualitative and quantitative data using joint display analysis to compare and contrast the results from the 2 stages of the study.RESULTS: In the interviews, general practitioners described appropriate ultrasound use as point-of-care examinations with a clear purpose and limited to predefined specific conditions within delimited anatomic areas. They stated that general practitioners should receive formalized ultrasound training and be skilled in the examinations they perform. In the cohort study, general practitioners performed ultrasound examinations of anatomic areas with or without a defined clinical suspicion. Some performed ultrasound examinations for which they had no previous training or skills.CONCLUSIONS: We found a difference between the ideas about the appropriate uses for ultrasound in general practice and the actual use by early adopters in clinical practice. Our findings suggest a need for evidence-based guidelines to support general practitioners in choosing which examinations to perform and strategies for developing and maintaining scanning competency.

Published
2022

46. One Hundred Children and Adolescents Consulting General Practice With Musculoskeletal Pain

Author

Pourbordbari, Negar, Jensen, Martin Bach, Olesen, Jens Lykkegaard, Holden, Sinead, and Rathleff, Michael Skovdal

Abstract

BackgroundEach year, 8% of all child and adolescent consultations in general practice are due to musculoskeletal conditions, with pain as the most frequent symptom. Despite the commonality of musculoskeletal pain, limited knowledge exists about care-seeking children and adolescents with musculoskeletal pain. The purpose of this study was to describe characteristics of children and adolescents consulting their general practitioner with musculoskeletal pain.MethodsThis is a cross-sectional study based on the baseline data from the child and adolescent musculoskeletal (ChiBPS) pain cohort study, carried out in 17 Danish general practice clinics. Patients aged 8-19 years with musculoskeletal pain complaints when consulting their GP completed a questionnaire on demographics, physical activity, pain impact, psychosocial factors, and expectations of their general practitioner. Descriptive statistics were used to summarize data. Normally distributed continuous data are described using mean and standard deviations while non-normally data are described using median and interquartile range. ResultsWe included 100 participants (54% female, median age 13 [12-16] years). The most frequent activity limiting pain regions were knee (56%), back (20%), ankle (19%), and neck (13%). The majority (63%) consulted their general practitioner because they were not able to use their body as usual due to pain. At time of consultation the median pain duration was 5 months [3 weeks-1 year]. Above a third were often or sometimes nervous (34%), worried or anxious (33%), and took pain medication when in pain (33%). Pain made it difficult to participate in sport activities at school (79%) and disturbed spare time activities (88%). Pain made it difficult to concentrate (58%) and to fall asleep (38%) and only 38% expected a pain free long-term future.ConclusionThis study demonstrates the bio-psycho-social impact of musculoskeletal pain in care-seeking children and adolescents. Demographics, pain characteristics, psychosocial characteristics, and physical characteristics should be included in addressing children and adolescents with musculoskeletal pain.Trial registrationThe ChiBPS study where the participants in this study are from, was pre-registered before recruitment (ClinicalTrials.gov Identifier: NCT03678922) date: 09.20.18.

Published
2021
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49. NKR: Behandling af patienter med subakromielt smertesyndrom i skulderen

Author

Delfi, Akram Dakhil, Sørensen, Anne Kathrine Belling, Pedersen, Carsten Boe, Olesen, Jens Lykkegaard, Barfod, Kristoffer W., Jensen, Martin Bach, Høgh, Morten, Jensen, Steen Lund, Svendsen, Susanne Wulff, Thillemann, Theis, and Liaghat, Behnam

Abstract

Sundhedsstyrelsen udgiver en opdateret vidensbaseret national klinisk retningslinje om behandling af patienter med subakromielt smertesyndrom af mere end en måneds varighed.Skuldersmerter er det tredje mest almindelige muskel-skelet-problem og en hyppig årsag til henvendelser til almen praksis. Retningslinjen præsenterer fire anbefalinger for udvalgte kliniske problemstillinger i det samlede behandlingsforløb inden for følgende områder:TræningsindsatserBehandling med glukokortikoid injektionPladsskabende operation under skulderhøjen (subakromiel dekompression) ved smerter i mindre end 6 månederSubakromiel dekompression ved symptomer i mere end 6 måneder og manglende effekt af et superviseret træningsforløbMed publicering af denne retningslinje udgår en tidligere retningslinje om skuldersmerter fra 2013. Den nye retningslinje ser udelukkende på behandling af skuldersmerter, hvor den tidligere retningslinje, også indeholdt nedslagspunkter om diagnostik, behandling og rehabiliteringLigeledes udgår Sundhedsstyrelsens faglige visitationsretningslinjer fra 2011 vedrørende udvalgte skulderproblemer, impingementsyndrom/rotator cuff-syndrom og traumatisk rotator cuff-ruptur, da disse retningslinjer ikke understøtter den nye kliniske retningslinje.

Published
2021

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