Telemedicine enhances quality of forced spirometry in primary care

Burgos, Felip; Disdier, Carlos; Santamaria, Elena Lopez de; Galdiz, Batxi; Roger, N.; Rivera, Marisa; Hervás, Ramona; Durán-Tauleria, Enric; Garcia‐Aymerich, Judith; Roca, Josep

doi:10.1183/09031936.00168010

Cited by 64 publications

(61 citation statements)

References 25 publications

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“…However, for large scale studies, one question will be how to achieve high quality in the most efficient way. While other investigators 4,5,[11][12][13]18 have shown good results using feedback on completed tests, the present study shows that if used with relevant instructions, automated real-time feedback of quality grade can also have a significant impact on quality, altering what happens during the session-which of course is very efficient.…”

Section: Discussionmentioning

confidence: 50%

Quality and learning aspects of the first 9000 spirometries in the LifeGene study

Qvarfordt

Anderson

Svartengren

2016

9.1 Respiratory Function Technologists/Scientists

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Spirometry requires the patient to cooperate and do the manoeuvre 'right' for reliable results. Algorithms to assess test quality as well as educational recommendations for personnel are defined in guidelines. We compared the quality of forced spirometry tests performed by spirometry technicians with little or no previous experience of spirometry using spirometry systems with different modes of feedback. In both cases, the spirometry technician received general feedback on the screen based on ATS/ERS guidelines, such as 'exhale faster' and 'exhale longer'. The major difference was whether quality grading system of the complete session was available simultaneously on screen, or in the printed report afterwards. Two parts of the same population-based study (LifeGene), the pilot (LG1) and the first part (LG2) of the subsequent study, were compared retrospectively. In LG1 (on-screen grading) approved examination quality was achieved for 88% of the 10 first subjects for each spirometry technician compared to 70% in LG2 (printed grading afterwards). The corresponding values after 40 subjects was 94 % in LG1, compared to 73% in LG2, and after the first ten subjects there was no apparent quality improvement in either LG1 or LG2. The quality for LG1 is among the highest reported in the literature even though the spirometry technician were relatively inexperienced. We conclude that on-screen grading in addition to general technical quality feedback is powerful in enhancing the spirometry test session quality.

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Section: Discussionmentioning

confidence: 50%

Quality and learning aspects of the first 9000 spirometries in the LifeGene study

Qvarfordt

Anderson

Svartengren

2016

9.1 Respiratory Function Technologists/Scientists

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“…We have no evidence of studies with difficult to control asthmatic patients as the next therapeutic step is to introduce monitoring through an e-health system [29][30][31][32][33]. Short term outcomes in our study show a decrease of patients attending emergency room for asthma exacerbations, as well as improved adherence and treatment compliance which is leading to favourable clinical consequences trough improving respiratory function.…”

Section: Conclusion and Discussionmentioning

confidence: 70%

“…An increasingly large number of applications in various medical specialties and in different fields of health are finding these technologies useful [31][32][33][34][35][36].…”

Section: Conclusion and Discussionmentioning

confidence: 99%

“…In addition, this study showed that at 12 months of follow-up, about 60% of the patients were still using the program of their own initiative. Van Gaalen et al [30] published a randomized controlled trial about Long-Term Outcomes of InternetBased Self-Management Support in Adults With asthma demonstrating that Improvements in asthma-related quality of life and asthma control were sustained in patients who received IBSM support for 1 year, even up to 1.5 years after terminating support although no differences for inhaled corticosteroid dosage or for lung function, measured as forced expiratory volume in 1 second [31,32].…”

Section: Introductionmentioning

confidence: 99%

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Application of Telemedicine for the Optimal Control of Asthma Patients

Cano¹,

Agustín²,

Royo³

et al. 2016

J Pulm Respir Med

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“…all primary care centres) is expensive and logistically complex. As we understand it, the best option for large primary care centres, with many patients needing spirometric studies, may be to perform the spirometries in a place with proper and periodic training, perhaps by telematic learning [8,13,36,38]. However, in smaller primary care centres with fewer patients and resources to professionally train workers to carry out spirometry, the online alternative may be preferable.…”

Section: Discussionmentioning

confidence: 99%

Validity of spirometry performed online

Masa¹,

González²,

Pereira³

et al. 2010

Eur Respir J

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Spirometry is essential for the diagnosis and management of common respiratory diseases. However, its use and quality are low in primary care. An important reason for this is the technical difficulty in performing conventional spirometry. If high-quality spirometry could be performed online, from the pulmonary function laboratory in hospitals, most of the technical problems could be solved. The aim of the present study was to compare spirometries performed online by remote technicians with conventional spirometry.This was a controlled, randomised crossover study of 261 patients referred from primary care centres for pulmonary consultation. They were randomised to undergo either conventional or online spirometry. The technician, located remotely, controlled the spirometer computer. Using a teleconference link, the technician guided the patient through the spirometry. The comparison between conventional and online spirometries was performed on intention to treat and per protocol bases for spirometric values and quality criteria. Agreement between the two spirometric methods was assessed with a Bland-Altman plot. A subpopulation of off-range patients was also characterised. Finally, intra-and interobserver agreement was evaluated using the intraclass correlation coefficient.No clinically significant differences were seen between the online and conventional spirometric values in both the intention to treat and per protocol analyses. The agreement in Bland-Altman analysis was poorer for intention to treat than for the per protocol analysis. The latter had a lower percentage of off-range patients and high agreement to determine abnormal spirometry in the offrange group. Conventional spirometry had a higher percentage of patients with spirometric quality criteria although the quality criteria difference was only 5.9%, when both procedures were the first to start. Very good agreement was found between intra-and interobserver reliability.Spirometry performed online from a hospital can be an adequate alternative to conventional spirometry for primary care centres.

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Telemedicine enhances quality of forced spirometry in primary care

Cited by 64 publications

References 25 publications

Quality and learning aspects of the first 9000 spirometries in the LifeGene study

Quality and learning aspects of the first 9000 spirometries in the LifeGene study

Application of Telemedicine for the Optimal Control of Asthma Patients

Validity of spirometry performed online

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