Current Use and Barriers to Point-of-Care Ultrasound in Primary Care: A National Survey of VA Medical Centers

Robert Nathanson, South Texas Veterans Health Care System, Medicine Service, San Antonio, Texas, USA; University of Texas Health San Antonio, Division of Hospital Medicine, San Antonio, Texas, USA. Electronic address: nathansonr3@uthscsa.edu.
Jason P. Williams, Atlanta VA Medical Center, Medicine Service, Atlanta, Georgia, USA; Emory School of Medicine, Division of Hospital Medicine, Atlanta, Georgia, USA. Electronic address: jason.phillip.wiliams@gmail.com.
Neil Gupta, Joe R. & Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA. Electronic address: guptan@livemail.uthscsa.edu.
Austin Rezigh, University of Texas Health San Antonio, Division of General Internal Medicine, San Antonio, Texas, USA. Electronic address: rezigh@uthscsa.edu.
Michael J. Mader, South Texas Veterans Health Care System, Research Service, San Antonio, Texas, USA. Electronic address: Michael.Mader2@va.gov.
Elizabeth K. Haro, University of Texas Health San Antonio, Division of Pulmonary Diseases & Critical Care Medicine, San Antonio, Texas, USA. Electronic address: haro@uthscsa.edu.
Brandy Drum, Health Analysis and Information Group, Department of Veterans Affairs, Milwaukee, Wisconsin, USA. Electronic address: brandy.drum@va.gov.
Edward O'Brien, Health Analysis and Information Group, Department of Veterans Affairs, Milwaukee, Wisconsin, USA. Electronic address: edward.obrien3@va.gov.
Rahul Khosla, Department of Pulmonary, Critical Care and Sleep Medicine, The George Washington University, Washington, DC, USA; Pulmonary and Critical Care Medicine, Veterans Affairs Medical Center, Washington, DC, USA.. Electronic address: rkhosla8@gmail.com.
Jeremy S. Boyd, Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee, USA; VA Tennessee Valley Healthcare System-Nashville, Department of Emergency Medicine, Nashville, Tennessee, USA. Electronic address: jeremy.s.boyd@vumc.org.
Brian Bales, Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee, USA; VA Tennessee Valley Healthcare System-Nashville, Department of Emergency Medicine, Nashville, Tennessee, USA. Electronic address: Brian.bales@vumc.org.
Erin Wetherbee, Pulmonary Section, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA; Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.. Electronic address: racix001@umn.edu.
Harald Sauthoff, Medicine Service, VA NY Harbor Healthcare System, New York, USA.; Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, New York. Electronic address: harald.sauthoff@nyulangone.org.
Christopher K. Schott, VA Pittsburgh Health Care Systems, Critical Care Service, Pittsburgh, Pennsylvania, USA; University of Pittsburgh, Departments of Critical Care Medicine and Emergency Medicine, Pittsburgh, Pennsylvania, USA. Electronic address: christopher.schott@va.gov.
Zahir Basrai, Emergency Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA; Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA. Electronic address: zahir.basrai@va.gov.
Dana Resop, Department of Emergency Medicine, University of Wisconsin, Madison, Wisconsin, USA; Emergency Department, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA. Electronic address: dmresop@medicine.wisc.edu.
Brian P. Lucas, White River Junction VA Medical Center, Medicine Service, White River Junction, Vermont, USA; Dartmouth Geisel School of Medicine, Department of Medicine, Hanover, New Hampshire, USA. Electronic address: brian.p.lucas@dartmouth.edu.
Nilam J. Soni, South Texas Veterans Health Care System, Medicine Service, San Antonio, Texas, USA; University of Texas Health San Antonio, Division of Hospital Medicine, San Antonio, Texas, USA; University of Texas Health San Antonio, Division of Pulmonary Diseases & Critical Care Medicine, San Antonio, Texas, USA. Electronic address: sonin@uthscsa.edu.

Document Type

Journal Article

Publication Date

2-22-2023

Journal

The American journal of medicine

DOI

10.1016/j.amjmed.2023.01.038

Keywords

barriers; point-of-care ultrasound; primary care; training

Abstract

BACKGROUND: More primary care providers (PCPs) have begun to embrace the use of point-of-care ultrasound (POCUS), but little is known about how PCPs are currently using POCUS and what barriers exist. In this prospective study, the largest systematic survey of POCUS use among PCPs in the VA Healthcare System, we assessed the current use, barriers to use, program management, and training needs for POCUS in primary care. METHODS: We conducted a prospective observational study of all VA Medical Centers (VAMCs) between August 2019 and March 2020 using a web-based survey sent to all VAMC Chiefs of Staff and Chiefs of primary care clinics (PCCs). RESULTS: Chiefs of PCCs at 105 VAMCs completed the survey (82% response rate). Only 13% of PCCs currently use POCUS, and the most common applications used are bladder and musculoskeletal ultrasound. Desire for POCUS training exceeded current use, but lack of trained providers (78%), ultrasound equipment (66%), and funding for training (41%) were common barriers. Program infrastructure to support POCUS use was uncommon, and only 9% of VAMCs had local policies related to POCUS. Most PCC chiefs (64%) would support POCUS training. CONCLUSIONS: Current use of POCUS in primary care is low despite the recent growth of POCUS training in Internal Medicine residency programs. Investment in POCUS training and program infrastructure is needed to expand POCUS use in primary care and ensure adequate supervision of trainees.

Department

Medicine

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