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Research ArticleORIGINAL RESEARCH

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

Camilla Aakjær Andersen, Timothy C. Guetterman, Michael D. Fetters, John Brodersen, Annette Sofie Davidsen, Ole Graumann and Martin Bach Jensen
The Annals of Family Medicine May 2022, 20 (3) 211-219; DOI: https://doi.org/10.1370/afm.2795
Camilla Aakjær Andersen
1Center for General Practice at Aalborg University, Aalborg, Denmark
MD, PhD
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  • For correspondence: caakjaer@dcm.aau.dk
Timothy C. Guetterman
2Mixed Methods Program and Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
PhD, MA
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Michael D. Fetters
2Mixed Methods Program and Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
MD, MPH, MA
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John Brodersen
3Research Unit for General Practice and Section of General Practice, Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
4Primary Health Care Research Unit, Region Zealand, Copenhagen, Denmark
MD, PhD
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Annette Sofie Davidsen
3Research Unit for General Practice and Section of General Practice, Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
MD, PhD, DMSc
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Ole Graumann
5Department of Radiology, Radiological Research and Innovation Unit, Odense University Hospital, Odense, Denmark
MD, PhD
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Martin Bach Jensen
1Center for General Practice at Aalborg University, Aalborg, Denmark
MD, PhD
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    Figure 1.

    Mixed methods findings on the purpose of POCUS in general practice.

    GP = general practitioner; Nonuser = a GP who is not using POCUS; POCUS = point-of-care ultrasonography; POCUS user = a GP who uses POCUS.

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    Figure 2.

    Mixed methods findings for the anatomical areas of POCUS examinations in general practice.

    DVT = deep vein thrombosis; GP = general practitioner; MSK = musculoskeletal; Nonuser = a GP who is not using POCUS; Ob/Gyn = obstetrics and/or gynecology; POCUS = point-of-care ultrasonography; POCUS user = a GP who uses POCUS; Subc Proc= subcutaneous processes.

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    Figure 3.

    Mixed methods findings for GPs POCUS training and competencies.

    GP = general practitioner; Nonuser = a GP who is not using POCUS; POCUS = point-of-care ultrasonography; POCUS user = a GP who uses POCUS.

    a All GPs had all participated in formalized training in the use of POCUS. Ten GPs had participated in musculoskeletal POCUS courses, 3 in abdominal courses, and 2 in gynecological/obstetric courses. Fifteen GPs had participated in an extensive 12-month POCUS course targeting general practice. Nine of these GPs had also taken additional courses. Finally, 5 GPs had previous experience with using more advanced ultrasonography in a hospital setting; 2 in cardiology and 3 in gynecology.

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    Figure 4.

    Mixed methods findings about GPs POCUS skills.

    GP = general practitioner; nonuser = a GP who is not using POCUS; POCUS = point-of-care ultrasonography; POCUS user = a GP who uses POCUS.

    a Skills were assessed using an adapted version of the generic Objective Structured Assessment of Ultrasound Skills assessment tool (Supplemental Appendix 2).

Tables

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    Table 1.

    Participating Physician Demographics

    Interview StageCohort StageOverall Populationa
    CharacteristicNonusers
    (n = 11)
    US users
    (n = 13)
    US Users
    (n = 20)
    GPs in Denmark
    (n = 3,402)
    Age, y
        <40202...
        40-501614...
        51-60543...
        61-70331...
    Mean age, y52.452.246.252.2
    Gender, No.
        Male711141,605
        Female4261,797
    Experience as a general practitioner,b y
        <1034......
        10-2036......
        >2053......
    Experience using POCUS in general practice, y
        <2...76...
        2-5...411...
        >5...23...
    Type of POCUS training, No.
        No training400...
        Residency610...
        Course054...
        Course and residency1716...
    Practice community character, No.
        Urban5812...
        Mixed556...
        Rural102...
    Practice region, No.
        North Denmark region324301
        Central Denmark region443807
        Region of Southern Denmark127782
        Region Zealand102460
        Capital region of Denmark2541,052
    Practice size, No. of patients
        <2,000243...
        2,000-5,0005410...
        >5,000457...
    Type of practice,c No.
        Partnership9917...
        Solo121929
        Collaboration122...
    • GP = general practitioner; POCUS = point-of-care ultrasonography; US = ultrasonography.

    • ↵a Data available from the Danish Medical Association (PLO faktaark 2018).

    • ↵b Becoming a GP in Demark requires a 6-year post-graduate specialization in family medicine. A few GPs may have been working or received training in other specialties before they entered family medicine training but there is no formal sub-specialization of Danish GPs.

    • ↵c Partnership practice is defined as a clinic owned and administrated by more than 1 GP. Solo practice is a clinic owned and administrated by just 1 GP. Collaboration practice is a clinic owned by 1 GP or several GPs, but administrated in collaboration with other GP clinics.

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  • SUPPLEMENTAL APPENDIXES IN PDF FILE BELOW

    • AndersenSuppApp.pdf -

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The Annals of Family Medicine: 20 (3)
The Annals of Family Medicine: 20 (3)
Vol. 20, Issue 3
1 May 2022
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General Practitioners’ Perspectives on Appropriate Use of Ultrasonography in Primary Care in Denmark: A Multistage Mixed Methods Study
Camilla Aakjær Andersen, Timothy C. Guetterman, Michael D. Fetters, John Brodersen, Annette Sofie Davidsen, Ole Graumann, Martin Bach Jensen
The Annals of Family Medicine May 2022, 20 (3) 211-219; DOI: 10.1370/afm.2795

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General Practitioners’ Perspectives on Appropriate Use of Ultrasonography in Primary Care in Denmark: A Multistage Mixed Methods Study
Camilla Aakjær Andersen, Timothy C. Guetterman, Michael D. Fetters, John Brodersen, Annette Sofie Davidsen, Ole Graumann, Martin Bach Jensen
The Annals of Family Medicine May 2022, 20 (3) 211-219; DOI: 10.1370/afm.2795
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