Should We Keep Pushing for a Spirometer in Every Doctor's Office?

Enright, Paul

doi:10.4187/respcare.01504

Cited by 21 publications

(17 citation statements)

References 64 publications

(42 reference statements)

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“…In contrast, a 70-min CD-ROM-based tutorial alone was shown to be ineffective [ 26 ], whereas remote delivery through telemedicine [ 27 , 28 ] or web-based interactive meetings [ 29 ] were effective. Our findings are congruent with this prior literature, and support the need for personalized training and ongoing feedback as part of an effective intervention [ 30 ].…”

Section: Discussionsupporting

confidence: 91%

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Effects of a 12-month multi-faceted mentoring intervention on knowledge, quality, and usage of spirometry in primary care: a before-and-after study

et al. 2016

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BackgroundAsthma is among the most common chronic diseases in adults. International guidelines have emphasized the importance of regular spirometry for asthma control evaluation. However, spirometry use in primary care remains low across jurisdictions. We sought to design and evaluate a knowledge translation intervention to address both the poor quality of spirometry and the underuse of spirometry in primary care.MethodsWe designed a 1-year intervention consisting of initial interactive education and hands-on training followed by unstructured peer expert mentoring (through an online portal, email, telephone, videoconference, fax, and/or in-person). We recruited physician and allied health mentees from across primary care sites in Ontario, Canada. We compared spirometry-related knowledge immediately before and after the 1-year intervention period and the quality of spirometry testing and the usage of spirometry in patients with asthma in the year before and the year of the intervention.ResultsSeven of 10 (70 %) invited sites participated, including 25/90 (28 %) invited allied health mentees and 23/68 (34 %) invited physician mentees. We recruited 7 physician mentors and 4 allied health mentors to form 3 mentor-mentee pods. Spirometry knowledge scores increased from 21.4 +/− 3.1 pre- to 27.3 +/− 3.5 (out of 35) (p < 0.01) post-intervention. Spirometry acceptability and repeatability criteria were met by 59/191 (30.9 %) spirometries and 86/193 (44.6 %) spirometries [odds ratio 1.7 (1.0, 3.0)], in the pre-intervention and intervention periods, respectively. Spirometry was ordered in 75/512 (14.6 %) and 129/336 (38.4 %) respiratory visits (p < 0.01), and in 20/3490 (0.6 %) and 36/2649 (1.4 %) non-respiratory visits (p < 0.01), in the pre-intervention and intervention periods, respectively.ConclusionsA mentorship-based intervention involving physicians and allied health team members can enhance knowledge, quality, and actual use of spirometry in real world primary care settings. A future controlled study should assess the impact of this intervention on patient outcomes, its cost-effectiveness, and its sustainability.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-016-0220-6) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 91%

“…2 ), which may have affected their ability to sustain a high level of technical competence. The quality and usability of the spirometer itself (including provision of quality warnings and guidance) may also influence technical competence [ 16 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

Effects of a 12-month multi-faceted mentoring intervention on knowledge, quality, and usage of spirometry in primary care: a before-and-after study

et al. 2016

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“…25 Using simple spirometry (ie, FEV 1 ) or even peak flow (PEF) to rule out airway abnormality in the majority of patients, followed by referral for more sophisticated pre/postbronchodilator studies in those remaining, may be the best alternative.…”

Section: Office Spirometrymentioning

confidence: 99%

Pulmonary Function Testing

2012

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Pulmonary function testing is often considered the basis for diagnosis in many categories of pulmonary disease. Although most of the testing methodologies are well established and widely employed, there are still many questions regarding how tests should be performed, how to ensure that reliable data are produced, what reference values and rules should be used, and how pulmonary function tests (PFTs) should be interpreted to best support clinical decision making. This conference was organized around a set of questions aimed at many of these issues. Each presenter was asked to address a specific topic regarding what tests should be done, how those test should be performed to answer a particular clinical question, and to relate test results to an accurate diagnosis and appropriate treatment of the patient. These topics included testing of adults and children, with concentration on important disease entities such as COPD, asthma, and unexplained dyspnea. Special emphasis was given to discussing reference values, lower limits of normal, interpretive strategies to optimize disease classification, and those factors directly affecting data quality. Established techniques for spirometry, lung volumes, diffusing capacity, exercise testing, and bronchial challenges were compared and contrasted with new technologies, and with technologies that might be part of pulmonary function laboratories in the near future.

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“…It is a matter of current debate whether spirometers should be in the hands of GPs, who are busy with numerous other health tasks and possibly perform spirometry only a couple of times a week [8]. However, the 10-year Finnish COPD program has proven that detection can be successful in primary care [14] when greater specialization of GPs is possible and community nurses provide spirometry for several offices.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, windows of opportunity for smoking cessation to stop further loss of lung function might be missed when early COPD goes undetected. The issue of the quality of spirometry in the detection of COPD in primary care has been discussed recently [7], but it is not yet clear whether spirometry should be done in primary-care practices or spirometry services should be offered to GPs [8,9]. …”

Section: Introductionmentioning

confidence: 99%

Detection of Chronic Obstructive Pulmonary Disease in Primary Care in Salzburg, Austria: Findings from the Real World

Weiss¹,

Steinacher²,

Lamprecht³

et al. 2013

Respiration

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Background: Chronic obstructive pulmonary disease (COPD) is a major public health burden and profoundly affects individuals suffering from the disease. However, the majority of subjects with COPD are still undiagnosed. Objectives: To evaluate COPD prevalence and detection strategies for COPD in the primary-care setting. Methods: The study was conducted in a random sample of general practitioner (GP) offices in Salzburg (Austria). A questionnaire and post-bronchodilator (PBD) spirometry was administered to patients aged ≥40 years. Nonreversible airway obstruction was considered when PBD FEV₁/FVC was <0.70. Severity of spirometrically defined COPD was graded according to the GOLD recommendations. Results: 60 GP offices were randomly selected for study participation, however only 30 (50.0%) were willing to participate. 1,230 of 9,820 (12.52%) patients consented to the protocol. Quality of PBD spirometry was evaluated, and 882 (71.7%) met ATS/ERS quality criteria. 7.5% (95% CI: 5.7-9.4%) of the patients had COPD grade II+ (FEV₁/FVC <0.7 and FEV₁ <80% of predicted), but only 22.4% of them reported a prior physician's diagnosis of COPD. Similar results were seen for the 2005 Salzburg BOLD (Burden of Obstructive Lung Disease) sample with regard to COPD GOLD II+ prevalence (10.7%) and proportion of underdiagnosis (82.3%). Conclusion: COPD in the primary-care setting is as prevalent and underdiagnosed as reported recently for the BOLD study. The surprisingly low participation rate of GPs and patients indicates that prevention of COPD is not a health priority, and that awareness for COPD has to heightened before case-finding strategies will be successful.

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Should We Keep Pushing for a Spirometer in Every Doctor's Office?

Cited by 21 publications

References 64 publications

Effects of a 12-month multi-faceted mentoring intervention on knowledge, quality, and usage of spirometry in primary care: a before-and-after study

Effects of a 12-month multi-faceted mentoring intervention on knowledge, quality, and usage of spirometry in primary care: a before-and-after study

Pulmonary Function Testing

Detection of Chronic Obstructive Pulmonary Disease in Primary Care in Salzburg, Austria: Findings from the Real World

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