Sociodemographic and Geographic Disparities in Obstetrical Ultrasound Imaging Utilization: A Population-based Study

Prenatal ultrasound utilization and associated factors among pregnant women attending antenatal care in south Wollo zone public hospitals, north east, Ethiopia, 2023

Background

Prenatal ultrasound (US) is essential in antenatal care worldwide and offers significant benefits for maternal and neonatal health. It should be a standard procedure in low- income countries. However, its utilization remains poor in nations such as Ethiopia.

Objective

This study aimed to assess the use of prenatal ultrasound and associated factors among pregnant women who attended antenatal care in South Wollo Zone Public Hospitals, Northeast Ethiopia, in 2023.

Method

An institution-based cross-sectional study was conducted among 590 pregnant women from December 30, 2022, to February 28, 2023, in selected South Wollo Zone Public Hospitals. The data were coded, cleaned, and entered into Epi-Data version 4.6 and subsequently exported to SPSS version 26 for analysis. The strength of the association between the dependent and independent variables was presented as odds ratios (ORs) at a 95% confidence interval (95% CI), with a P-value of less than 0.05 according to multivariable logistic regression.

Results

The prevalence of prenatal ultrasound utilization was 62.8% [95% CI: 58.7%-66.8%]. The significant factors associated with utilization included urban residency (AOR = 4.82, 95% CI: 2.99-8.03), mothers' knowledge (AOR = 7.36, 95% CI: 4.06-13.32), educational status above primary (AOR = 2.10, 95% CI: 1.09-4.05), medical illness (AOR = 3.03, 95% CI: 1.64-5.59), government employment (AOR = 4.05, 95% CI: 1.70-9.64), and private employment (AOR = 2.34, 95% CI: 1.58-7.05).

Conclusion

The proportion of patients who underwent prenatal ultrasound was lower than the WHO recommendation. The factors most significantly associated with ultrasound utilization were women's knowledge, urban residency, educational status, medical illness, and occupation. Therefore, the author recommended for health care providers educating mothers on the purposes of obstetric ultrasound and including a prenatal ultrasound screening as part of antenatal care is needed.

Screening for Structural Heart Defects: A Single-Center Retrospective Cost Analysis for Fetal Echocardiography in Adults with Congenital Heart Disease

Fetal echocardiography (FE) is recommended for parents with congenital heart disease (pCHD) due to a 3-6% recurrence risk of congenital heart disease (CHD). This study aimed to evaluate the cost of FE for detecting neonatal CHD in pCHD. FE data were collected between 12/2015 and 12/2022. Parents were stratified by CHD complexity: "simple" (class I) and "complex" (class II/III). Cost analysis compared universal FE with selective FE following a positive level II screening anatomical ultrasound (SAU). Primary outcomes included the cost and number needed to screen (NNT) to detect one case of neonatal CHD. Of 419 pCHD cases, 48 were analyzed separately due to additional FE indications. Among the remaining 371 cases (73% maternal, 27% paternal; mean maternal age: 31 years), 14 postnatal CHD cases were detected (3.8%). Recurrence rates were 1.9% for simple pCHD (n = 156) and 5.1% for complex pCHD (n = 215). Universal FE increased the cost of detecting neonatal CHD. The cost per detected case was $267,157 for simple CHD (NNT = 560) and $135,125 for complex CHD (NNT = 288). The lower sensitivity of SAU reduced the cost of universal FE. In this single-center cohort, the recurrence risk of CHD in pCHD is higher than in the general population, particularly in complex cases. Universal screening in simple pCHD is costlier with high-sensitivity SAU. Targeted screening in complex pCHD may offer a better cost-to-risk ratio, highlighting the need for early detection to improve outcomes. The cost effectiveness is dependent on local SAU sensitivity rates.

Standardizing Virtual Healthcare Deployment: Insights From the Implementation of Telerobotic Ultrasound to Bridge Healthcare Inequities in Rural and Remote Communities Across Canada

The COVID-19 pandemic has accelerated the integration of virtual care into healthcare systems, presenting a unique opportunity to address healthcare inequities in rural and remote communities, particularly those that are Indigenous. This commentary outlines critical steps and best practices for deploying virtual care in underserved regions, drawing on over a decade of experience in Saskatchewan. Key recommendations include creating detailed community profiles, assessing digital literacy, and using standardized readiness tools to evaluate infrastructure and clinical needs. A weighted prioritization framework ensures efficient resource allocation, while partnerships with Indigenous-led institutions, such as SIIT, equip local healthcare assistants to support virtual care delivery. Examples from successful telerobotic ultrasonography deployments in the rural and remote communities of Saskatchewan highlight the potential of virtual care to improve healthcare access, outcomes, and sustainability. By tailoring interventions to community-specific contexts and involving local stakeholders, virtual care can bridge health disparities and serve as a replicable model for similar settings worldwide.

A comprehensive evaluation tool to assess community capacity and readiness for virtual care implementation

INTRODUCTION

The rapid evolution and implementation of virtual care technologies for clinical use often exceeds the development of standardized implementation protocols, leading to gaps in the equitable and sustainable adoption of virtual care services, particularly in rural and remote areas. This paper introduces a comprehensive evaluation tool designed to assess community capacity and readiness for virtual care.

METHODS

The development of the tool was informed by experiences from the Virtual Care and Robotics Program at the University of Saskatchewan. It involved a collaborative, multi-stakeholder approach that engaged healthcare leaders, IT experts and community healthcare workers. This iterative process included defining evaluation categories, mapping evaluative domains and refining the tool into a user-friendly checklist manual.

RESULTS

The tool identifies three key domains for assessing readiness: clinical needs, technology infrastructure and human resources/workflows. It was piloted in the remote community of Fond du Lac, Saskatchewan, where it successfully qualified the community for implementing telerobotic ultrasound services. The tool facilitated local engagement and highlighted the community's specific needs and readiness, enhancing the implementation process.

CONCLUSION

This evaluation tool contributes to bridging the gap between the rapid deployment of virtual care technologies and the need for comprehensive, standardized implementation protocols. It offers a structured, practical approach to assessing and enhancing community readiness for virtual care while promoting successful clinical implementation and equitable access to healthcare.

Canadian midwives' perspectives on the clinical impacts of point of care ultrasound in obstetrical care: A concurrent mixed-methods study

Introduction

Point of Care Ultrasound (POCUS) is used globally in obstetrics to conduct real time bedside ultrasound scans to answer a clinical question, and it may be conducted by a non-sonography healthcare practitioner. The College of Midwives of Ontario expanded the scope of practice in 2018 to allow registered midwives to perform POCUS during clinical assessments. In response, a POCUS training curriculum for practicing midwives was developed. This paper reports on the perceptions of learners about the impact of this training on their clinical practice.

Methods

We conducted a mixed-methods study to understand learner perceptions. Data collection included surveys at four time points over a year, and semi-structured interviews. Quantitative data were analyzed through descriptive statistics, and qualitative analyses used a constructivist approach to grounded theory.

Results

The frequency of POCUS use within antenatal care increased among learners, with common applications including assessment of fetal presentation and confirmation of viability. POCUS was seen to holistically aid practitioners care by providing additional skills and knowledge to improve care quality and access to care, particularly for remote areas where ultrasounds are not easily available. However, participants articulated a need for clearer regulatory guidelines outlining how this technology should be applied in midwifery. Equipment purchasing and maintaining costs were a barrier for many midwives.

Conclusions

Participants who had access to a device are continuing to use sonography within their clinics to provide comprehensive midwifery care informed by real-time ultrasound assessments. POCUS scans were seen to offer many benefits to improve patient care.

The Impact of the Dobbs Decision on Diagnostic Radiology Applicants, Residents, and Program Directors

In the Dobbs decision the United States Supreme Court overturned Roe v. Wade, returning the issue of abortion to the states. To date, there is little published data on the impact this might have on where future residents choose to pursue graduate medical education. We investigated the potential effects of the resultant varied political landscape of abortion care access laws with respect to influence on the selection of prospective diagnostic radiology training programs by medical students, comparing application rates for the 2022 recruitment cycle to the prior 4 years across a geographically diverse group of 22 academic and community sites across the United States. We provide strategies for program directors to consider in dealing with topics related to this continually evolving issue as it pertains to resident recruitment and retention.

Economic Evaluation of Telerobotic Ultrasound Technology to Remotely Provide Ultrasound Services in Rural and Remote Communities

INTRODUCTION

Telerobotic ultrasound technology allows radiologists and sonographers to remotely provide ultrasound services in underserved areas. This study aimed to compare costs associated with using telerobotic ultrasound to provide ultrasound services in rural and remote communities to costs associated with alternate models.

METHODS

A cost-minimization approach was used to compare four ultrasound service delivery models: telerobotic ultrasound (Model 1), telerobotic ultrasound and an itinerant sonographer (Model 2), itinerant sonographer without telerobotic ultrasound (Model 3), and travel to another community for all exams (Model 4). In Models 1-3, travel was assumed when exams could not be successfully performed telerobotically or by an itinerant sonographer. A publicly funded healthcare payer perspective was used for the reference case and a societal perspective was used for a secondary non-reference case. Costs were based on the literature and experience using telerobotic ultrasound in Saskatchewan, Canada. Costs were expressed in 2020 Canadian dollars.

RESULTS

Average cost per ultrasound exam was $342, $323, $368, and $478 for Models 1, 2, 3, and 4, respectively, from a publicly funded healthcare payer perspective, and $461, $355, $447, and $849, respectively, from a societal perspective. In one-way sensitivity analyses, Model 2 was the lowest cost from a payer perspective for communities with population >2075 people, distance >350 km from the nearest ultrasound facility, or >47% of the population eligible for publicly funded medical transportation.

CONCLUSION

Health systems may wish to consider solutions such as telerobotic ultrasound and itinerant sonographers to reduce healthcare costs and improve access to ultrasound in rural and remote communities.

Sociodemographic and Geographic Factors Associated With Non-Obstetrical Ultrasound Imaging Utilization: A Population-Based Study

OBJECTIVE

Ultrasound is one of the most commonly used imaging modalities, though some populations face barriers in accessing ultrasound services, potentially resulting in disparities in utilization. The objective of this study was to assess the association between sociodemographic and geographic factors and non-obstetrical ultrasound utilization in the province of Saskatchewan, Canada.

METHODS

All non-obstetrical ultrasound exams performed from 2014 to 2018 in Saskatchewan, Canada were retrospectively identified from province-wide databases. Univariate and multivariate Poisson regression analyses were performed to assess the association between ultrasound utilization and sex, age, First Nations status, Charlson Comorbidity Index, urban vs. rural residence, geographic remoteness, and neighborhood income.

RESULTS

A total of 1,324,846 individuals (5,857,044 person-years) were included in the analysis. Female sex (adjusted incidence rate ratio [aIRR], 2.20; 95% confidence interval [CI], 2.19-2.22), age (aIRR, 4.97; 95% CI, 4.90-5.05 for ≥57 years vs. <11 years), comorbidities (aIRR, 4.36 for Charlson Comorbidity Index >10 vs. 0; 95% CI, 3.78-5.03), and higher neighborhood income (aIRR, 1.04; 95% CI, 1.02-1.05 for highest vs. lowest quintile) were associated with higher rates of ultrasound utilization. Individuals who were status First Nations (aIRR, 0.91; 95% CI, 0.90-0.92) or resided in geographically remote areas (aIRR, 0.87 for most vs. least remote; 95% CI, 0.83-0.91) had lower rates of ultrasound utilization. Individuals who lived in a rural area also had lower rates of ultrasound utilization (aIRR, 0.93; 95% CI, 0.92-0.94).

CONCLUSION

Substantial disparities exist in non-obstetrical ultrasound utilization among individuals in low-income neighborhoods, status First Nations individuals, and individuals in rural and remote communities.