Kerry Anderson

Background:  Point-of-Care Ultrasound (POCUS) is a non-invasive technology using sound waves to visualize internal anatomic structures. A transducer is placed on the patient’s skin covered in a gel and sends a sound wave into the body. The reflection of the sound is recorded by the machine and displayed as a sonogram. It is commonly used in healthcare facilities by physicians, but its availability and usage in rural and remote areas varies considerably from their urban counterparts. Only 39% of rural counties in the US have access to ultrasound compared to nearly 90% of metro counties [1]. The lack of ultrasound access prevents healthcare providers from utilizing its capabilities in obstetrics, triage, and other diagnostic modalities. The limited ultrasound use is associated with increased costs and decreased healthcare outcomes due to the increased travel distances for standard-of-care imaging [1]. This review will examine factors contributing to the reduced usage of ultrasound in rural healthcare environments.

Methods: PubMed database search including the terms: ‘ultrasound’, ‘rural’, ‘remote’, and ‘access’.

Results: There were several different factors identified that contributed to the high disparity in ultrasound access between rural and urban healthcare. Data pulled from Medicare records shows a stark contrast in ultrasound usage between rural, urbanized, and metro areas in the United States [1]. One major factor was the equipment cost that prevented clinicians from using ultrasound. Training is another significant barrier to ultrasound utilization, with several studies noting that lack of training for the clinical staff contributes to ultrasound not being utilized [2,3]. Even when provided equipment and limited training at no cost, many physicians cited low confidence in their ability to use ultrasound in their practice [2]. There are some studies showing potential for rapid training methods and use of telemedicine to remotely provide ultrasound services using non-expert clinicians [3,4].

Conclusions: The lack of ultrasound access in rural counties is an important factor contributing to worse healthcare outcomes for patients in the county. The significant gap in Point-of-Care Ultrasound (POCUS) access between rural and urban healthcare settings stems from multiple factors, including cost barriers, inadequate training, and low clinician skill in using ultrasound. Addressing these challenges through innovative solutions like telemedicine/telemonitoring and rapid technician training programs could improve ultrasound utilization and subsequently enhance healthcare outcomes in rural areas while lowering overall costs to patients and rural hospitals.

Works Cited

1. Peterman NJ, Yeo E, Kaptur B, et al. Analysis of Rural Disparities in Ultrasound Access. Cureus. 2022;14(5):e25425. Published 2022 May 28. doi:10.7759/cureus.25425
2. Phillips H, Sukheja N, Williams S, et al. Point-of-care ultrasound in general practice: an exploratory study in rural South Australia. Rural Remote Health. 2023;23(1):7627. doi:10.22605/RRH7627
3. Marini TJ, Oppenheimer DC, Baran TM, et al. Testing telediagnostic right upper quadrant abdominal ultrasound in Peru: A new horizon in expanding access to imaging in rural and underserved areas. PLoS One. 2021;16(8):e0255919. Published 2021 Aug 11. doi:10.1371/journal.pone.0255919
4. Katende A, Oehri J, Urio VZ, et al. Use of a Handheld Ultrasonographic Device to Identify Heart Failure and Pulmonary Disease in Rural Africa. JAMA Netw Open. 2024;7(2):e240577. doi:10.1001/jamanetworkopen.2024.0577