Gaping inequality in access to prenatal ultrasound in rural areas

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A survey of clinicians in rural and remote areas shows the challenges of delivering care that is considered routine in cities.

Remote areas often lack trained personnel, as well as ultrasound equipment.


The researchers called for more investment in portable ultrasound machines and improved skills to tackle stark inequalities in prenatal care in rural areas.


The perinatal mortality rate in very remote areas is more than double the metropolitan level, and a study from the University of South Australia (UniSA) suggests that better access to prenatal ultrasound is key to closing this gap .


Analyzing the results of a survey of 114 healthcare professionals across the country, the UniSA study authors called for “a coordinated approach.” They cite statistics from the Australian Institute of Health and Welfare (AIHW) which show a rate of 19.6 deaths per 1,000 births in very remote areas, compared to a national average of 9.6 per 1,000 .


‘The most significant barriers to the provision of prenatal ultrasound services identified in this survey were: lack of trained personnel [including access to training opportunities] and the inaccessibility of ultrasound equipment,” they wrote.


Dr. Kaylene Girgenti is Chair of the RACGP Physicians for Women in Rural Medicine Committee and acknowledges the issues addressed in the study. She describes access to ultrasound in rural areas as “a huge deficit”.


“I am constantly shocked and amazed at the distance people sometimes have to travel to access these services,” she said. newsGP.


“Driving for seven hours for basic routine imaging is just crazy, and it’s no surprise that people sometimes choose not to.”


While the survey suggests that the problem may be partly related to the fact that pregnant patients in more remote areas do not recognize the value of ultrasound as much as their metropolitan counterparts, Dr. Girgenti thinks the logistics are probably the most important factor.


“Taking into account the investment of time, the costs of fuel and travel, the need to arrange childcare and reorganize all family life, they are probably making the decision and the choice that they can s ‘get over it,’ said Dr Girgenti.


One of the study’s authors, Amber Bidner, is also a research project leader for the ongoing UniSA Healthy Newborn Project, where she works with colleagues Associate Professor Nayana Parange and Professor Eva Bezak.


Funded by The Hospital Research Foundation, the project aims to give remote doctors and midwives more opportunities to use prenatal ultrasound and has run training courses for clinicians, including GPs, in Adelaide and in Alice Springs.


Ms. Bidner, who previously worked as a registered nurse and a nuclear medicine scientist, believes that scan costs and Medicare reimbursements for prenatal imaging need to be reviewed.

She says that historically there has been a very patchy approach to ultrasound in remote areas.


“One interviewee said, ‘I use my phone with FaceTime while the clinician is on the other end to tell me where to hold the probe, and I haven’t received any training,'” she said. newsGP.


“There is no ultrasound legislation in terms of who can and cannot use it, so any clinician could just buy their own ultrasound machine and start scanning – and that would obviously lead to risk of misdiagnosis and all sorts of other problems. ‘


One of the clear goals of improving access and training is to increase the detection of high-risk pregnancies and fetal abnormalities.


“Ultrasound … picks up these things, which then helps provide care to prevent mortality down the road and provide a better plan to care for these women,” Ms Bidner said.


She reports that clinicians who have participated in the training are also seeing another important effect.


“They find that patients attend their appointments more regularly, that they become more engaged in the pregnancy, that they follow their care guidelines more,” she said.


“Ultrasound is a great tool to guide care.”


Ms. Bidner also stresses the importance of follow-up training.


“We’ve proven that we can upskill clinicians with these intensive training programs, but you can’t just send them back to the back of Central Australia and ‘see you guys later’,” a- she declared.


“Ultrasound is a very operator-dependent skill, and they need extra support afterwards.”


According to Ms. Bidner, technology also facilitates this.


“We’re seeing these incredible systems become available where the clinician can use the ultrasound probe and the specialist is sitting hundreds of miles away in a city center,” she said.


“They can not only see the patient and the probe and where it is positioned, but also the scan itself.


“And they can also control certain features of ultrasound equipment.”


She would like to see more clinicians move from point-of-care ultrasound training to full accreditation through the Australasian Society of Ultrasound and Medicine (ASUM).


Ms Bidner also hopes that a sustainable and accessible program for all of rural Australia can be developed, with the collaboration of ASUM and potentially other organisations, including the RACGP.


“With all the issues we have with attrition of rural clinicians, giving them that skill and that support to be able to set up a program like this…would really help empower them and keep them in rural workplaces “, she said.


For Dr. Girgenti, such a move would be worthwhile, provided that the newly developed expertise can be put into practice.


“Improving GP skills and ultrasound skills would be a valuable investment, as long as GPs can use these skills regularly,” she said.


“That’s the most important thing.”



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