Physician Barriers and Facilitators for Screening for Congenital Heart Disease With Routine Obstetric Ultrasound: A National United States Survey.

Autor: Pinto NM; Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA., Henry KA; Department of Geography, Temple University, Philadelphia, Pennsylvania, USA., Grobman WA; Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA., Ness A; Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California, USA., Miller S; Division of Pediatric Cardiology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA., Ellestad S; Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA., Gotteiner N; Division of Pediatric Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA., Tacy T; Division of Cardiology, Department of Pediatrics, Stanford University, Palo Alto, California, USA., Wei G; Division of Biostatistics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA., Minich LL; Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA., Kinney AY; Department of Biostatistics and Epidemiology, School of Public Health, and Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey, USA.
Jazyk: angličtina
Zdroj: Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine [J Ultrasound Med] 2020 Jun; Vol. 39 (6), pp. 1143-1153. Date of Electronic Publication: 2019 Dec 24.
DOI: 10.1002/jum.15199
Abstrakt: Objectives: Prenatal detection of congenital heart disease with obstetric screening remains at less than 50% in most population studies, far from what is thought to be achievable. We sought to identify barriers/facilitators for screening from the perspective of interpreting physicians and to understand how these barriers/facilitators may be associated with interpretation of screening images.
Methods: Our mixed-methods studies included 4 focus groups in centers across the United States with obstetric, maternal-fetal medicine, and radiology providers who interpreted obstetric ultrasound studies. Themes around barriers/facilitators for fetal heart screening were coded from transcripts. A national Web-based survey was then conducted, which quantitatively measured reported barriers/facilitators and measured physicians' ability to interpret fetal heart-screening images. Multivariable generalized linear random-effect models assessed the association between barriers/facilitators and the accuracy of image interpretation at the image level.
Results: Three main themes were identified in the focus groups: intrinsic barriers (ie, comfort with screening), external barriers (ie, lack of feedback), and organizational barriers (ie, study volumes). Among 190 physician respondents, 104 interpreted ultrasound studies. Perceptions of barriers varied by practice setting, with nontertiary providers having lower self-efficacy and perceived usefulness of cardiac screening. Facilitators associated with the odds of accurate interpretation of screening images were knowledge (odds ratio, 2.54; P = .002) and the volume of scans per week (odds ratio, 1.01 for every additional scan; P = .04).
Conclusions: Some of the main barriers to cardiac screening identified and prioritized by physicians across the United States were knowledge of screening and minimal volumes of scans. Targeting these barriers will aid in improving prenatal detection of congenital heart disease.
(© 2019 by the American Institute of Ultrasound in Medicine.)
Databáze: MEDLINE
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