Can Access to Spirometry in Asthma Education Centres Influence the Referral Rate by Primary Physicians for Education?

Abstract

M Labrecque, M Lavallée, MF Beauchesne, A Cartier, LP Boulet. Can access to spirometry in asthma education centres influence the referral rate by primary physicians for education? Can Respir J 2006;13(8):427-431.BACKGROUND AND OBJECTIVES: Asthma remains uncontrolled in a large number of asthmatic patients. Recent surveys have shown that a minority of asthmatic patients are referred to asthma educators.The objective of the present study was to assess the influence of increased access to spirometry in asthma education centres (AECs) on the rate of patient referrals to these centres by general practitioners. METHODS: A one-year, prospective, randomized, multicentric, parallel group study was conducted over two consecutive periods of six months each, with added spirometry being offered in the second sixmonth period to the experimental group. Ten AECs were enrolled in the project. An advertisement describing the AECs' services was sent by mail to a total of 303 general practitioners at the start of each period, inviting them to refer their patients. Measures of the frequency of medical referrals to the AECs were assessed for each period. RESULTS: The group of AECs randomly selected for spirometry in the second six-month period received 48 medical referrals during the first period and 32 during the second one, following proposed spirometry. AECs that had not offered spirometry received five referrals during the first period and seven during the second period. One AEC withdrew a few weeks after the study began and others encountered administrative problems, reducing their ability to provide interventions. CONCLUSIONS: Referral to AECs is not yet integrated into the primary care of asthma and offering more rapid access to spirometry in the AECs does not seem to be a significant incentive for such referrals.

Physician agreement regarding the expansion of pharmacist professional activities in the management of patients with asthma

“…Despite guidelines recommending spirometry at each visit to complement the clinical assessment of asthma control, objective lung testing remains underused by physicians even when accessible . Our study suggests that a pharmacy‐based asthma management programme including spirometry, would be particularly welcomed by physicians recently in practice, emergency physicians and those recognising the importance of lung function for preschoolers, in whom the diagnosis and assessment are most challenging.…”

“…Such programme may thus markedly increase access to, and monitoring with, lung function testing, an valued option to bridge the actual care gap. Perhaps, the observed resistance to pharmacy‐based lung function testing relates to physicians’ low perceived usefulness of spirometry and their own discomfort in its interpretation …”

“…Perhaps, the observed resistance to pharmacy-based lung function testing relates to physicians' low perceived usefulness of spirometry and their own discomfort in its interpretation. [8] Of interest, physicians recently in practice and emergency physicians showed the strongest endorsement to the three least endorsed professional activities. Other factors, such as academic or community practice setting were not significantly associated with endorsement.…”

“…National and international guidelines regular monitoring of asthma control, patient asthma education, use of written self‐management, plans and daily asthma controller medication in individuals with persistent asthma . Yet, only a minority of patients have received asthma education, own a self‐management plan, or have benefited from spirometric testing . Patient management is clearly improved by a multidisciplinary team approach in the context of a chronic care model.…”

“…[3] Yet, only a minority of patients have received asthma education, own a self-management plan, or have benefited from spirometric testing. [7,8] Patient management is clearly improved by a multidisciplinary team approach in the context of a chronic care model. Indeed, interdisciplinary asthma management has been shown to be effective in increasing the possession of a self-management plan, drug adherence, monitoring of lung function via peak flow metres and raising patient quality of life.…”