Impact of an educational intervention on the quality of spirometry performance in a general practice: an audit

Carr, Robin; Telford, Vicky; Waters, Gareth

doi:10.4104/pcrj.2011.00006

Cited by 15 publications

(13 citation statements)

References 8 publications

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“…A UK-based before-and-after study 267 aimed to assess the impact of an educational intervention on the quality of spirometry. The study found a positive impact on assessment quality, and a potential reduction in referrals to specialist services following GP training.…”

Section: Harris Et Almentioning

confidence: 99%

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Evidence for models of diagnostic service provision in the community: literature mapping exercise and focused rapid reviews

Chambers

Baxter

Johnson

et al. 2016

Health Serv Deliv Res

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BackgroundCurrent NHS policy favours the expansion of diagnostic testing services in community and primary care settings.ObjectivesOur objectives were to identify current models of community diagnostic services in the UK and internationally and to assess the evidence for quality, safety and clinical effectiveness of such services. We were also interested in whether or not there is any evidence to support a broader range of diagnostic tests being provided in the community.Review methodsWe performed an initial broad literature mapping exercise to assess the quantity and nature of the published research evidence. The results were used to inform selection of three areas for investigation in more detail. We chose to perform focused reviews on logistics of diagnostic modalities in primary care (because the relevant issues differ widely between different types of test); diagnostic ultrasound (a key diagnostic technology affected by developments in equipment); and a diagnostic pathway (assessment of breathlessness) typically delivered wholly or partly in primary care/community settings. Databases and other sources searched, and search dates, were decided individually for each review. Quantitative and qualitative systematic reviews and primary studies of any design were eligible for inclusion.ResultsWe identified seven main models of service that are delivered in primary care/community settings and in most cases with the possible involvement of community/primary care staff. Not all of these models are relevant to all types of diagnostic test. Overall, the evidence base for community- and primary care-based diagnostic services was limited, with very few controlled studies comparing different models of service. We found evidence from different settings that these services can reduce referrals to secondary care and allow more patients to be managed in primary care, but the quality of the research was generally poor. Evidence on the quality (including diagnostic accuracy and appropriateness of test ordering) and safety of such services was mixed.ConclusionsIn the absence of clear evidence of superior clinical effectiveness and cost-effectiveness, the expansion of community-based services appears to be driven by other factors. These include policies to encourage moving services out of hospitals; the promise of reduced waiting times for diagnosis; the availability of a wider range of suitable tests and/or cheaper, more user-friendly equipment; and the ability of commercial providers to bid for NHS contracts. However, service development also faces a number of barriers, including issues related to staffing, training, governance and quality control.LimitationsWe have not attempted to cover all types of diagnostic technology in equal depth. Time and staff resources constrained our ability to carry out review processes in duplicate. Research in this field is limited by the difficulty of obtaining, from publicly available sources, up-to-date information about what models of service are commissioned, where and from which providers.Future workThere is a need for research to compare the outcomes of different service models using robust study designs. Comparisons of ‘true’ community-based services with secondary care-based open-access services and rapid access clinics would be particularly valuable. There are specific needs for economic evaluations and for studies that incorporate effects on the wider health system. There appears to be no easy way of identifying what services are being commissioned from whom and keeping up with local evaluations of new services, suggesting a need to improve the availability of information in this area.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Harris Et Almentioning

confidence: 99%

“…Only three 261,267,273 of the papers in this group examining the use of technologies in primary care were from the UK, although there appear to be no features of the studies, which would suggest that they would not be applicable to the UK health-care context.…”

Section: Summary Of Evidence From Intervention Studiesmentioning

confidence: 99%

Evidence for models of diagnostic service provision in the community: literature mapping exercise and focused rapid reviews

Chambers

Baxter

Johnson

et al. 2016

Health Serv Deliv Res

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“…The primary focus of EPI-SCAN was chronic obstructive pulmonary disease (COPD), with results to date available elsewhere. [24][25][26][27][28] A restrictive ventilatory defect was defined as an FEV1/FVC >0.70 and an FVC <80% predicted. By definition and design (Figure 1), an EPI-SCAN participant diagnosed as having COPD according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) cannot have a restrictive ventilatory defect.…”

Section: Spirometrymentioning

confidence: 99%

Spirometrically-defined restrictive ventilatory defect: population variability and individual determinants

Soriano

Miravitlles

García‐Río

et al. 2012

Primary Care Respiratory Journal

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“…29,30 Examples in the context of primary care management of respiratory conditions include a case study of audit and education which reduced technical errors in the performance of spirometry (and subsequent referrals) in a single general practice. 31 Similarly, …”

Section: Audit and Feedbackmentioning

confidence: 98%

Effecting change in primary care management of respiratory conditions: a global scoping exercise and literature review of educational interventions to inform the IPCRG's E-Quality initiative

McDonnell¹,

Williams²,

Chavannes

et al. 2012

Primary Care Respiratory Journal

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This discussion paper describes a scoping exercise and literature review commissioned by the International Primary Care Respiratory Group (IPCRG) to inform their E-Quality programme which seeks to support small-scale educational projects to improve respiratory management in primary care. Our narrative review synthesises information from three sources: publications concerning the global context and health systems development; a literature search of Medline, CINAHL and Cochrane databases; and a series of eight interviews conducted with members of the IPCRG faculty. Educational interventions sit within complex healthcare, economic, and policy contexts. It is essential that any development project considers the local circumstances in terms of economic resources, political circumstances, organisation and administrative capacities, as well as the specific quality issue to be addressed. There is limited evidence (in terms of changed clinician behaviour and/or improved health outcomes) regarding the merits of different educational and quality improvement approaches. Features of educational interventions that were most likely to show some evidence of effectiveness included being carefully designed, multifaceted, engaged health professionals in their learning, provided ongoing support, were sensitive to local circumstances, and delivered in combination with other quality improvement strategies. To be effective, educational interventions must consider the complex healthcare systems within which they operate. The criteria for the IPCRG E-Quality awards thus require applicants not only to describe their proposed educational initiative but also to consider the practical and local barriers to successful implementation, and to propose a robust evaluation in terms of changed clinician behaviour or improved health outcomes.

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Impact of an educational intervention on the quality of spirometry performance in a general practice: an audit

Cited by 15 publications

References 8 publications

Evidence for models of diagnostic service provision in the community: literature mapping exercise and focused rapid reviews

Evidence for models of diagnostic service provision in the community: literature mapping exercise and focused rapid reviews

Spirometrically-defined restrictive ventilatory defect: population variability and individual determinants

Effecting change in primary care management of respiratory conditions: a global scoping exercise and literature review of educational interventions to inform the IPCRG's E-Quality initiative

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