The development of a community-based spirometry service in the Canterbury region of New Zealand: observations on new service delivery

Abstract

In 2008, as part of the changes to develop integrated health care services in the Canterbury region of New Zealand, the local health board in collaboration with general practitioners, respiratory specialists and scientists introduced a programme for general practices to provide laboratory-quality spirometry in the community. The service adhered to the 2005 ATS/ERS international spirometry standards. The spirometry service was provided by trained practice nurses and community respiratory nurses, and was monitored and quality assured by certified respiratory scientists in the Respiratory Physiology Laboratory, Christchurch Hospital and CISO (Canterbury Initiative Services Organisation). These two organisations were responsible for organising training seminars and refresher courses on spirometry technique and interpretation of results. A total of 10 practices have now become approved spirometry providers, with the number of tests carried out in the primary care setting increasing gradually. Consistently high-quality spirometry tests have been obtained and are now presented on a centrally available results database for all hospital and community clinicians to review. Although the service has proved to be more convenient for patients, the tests have not been delivered as quickly as those carried out by the Respiratory Physiology Laboratory. However, the time scales for testing achieved by the community service is considered suitable for investigation of chronic disease. The success of the service has been dependent on several key factors including hospital and clinical support and a centralised quality assurance programme, a comprehensive training schedule and online clinical guidance and close integration between primary and secondary care clinicians.

Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement

“…It is the responsibility of the operator to observe and engage with the patient to achieve optimal results, which requires a combination of training and experience. Training courses for conducting quality spirometry testing are available in many countries, which has led to operators following ATS/ERS standards ( 14 , 15 , 49 – 51 ), but short-term follow-up and supplementary training are important to maintain quality ( 52 , 53 ). Operator training and attainment and maintenance of competency must be integrated in any spirometry testing service ( 54 ).…”

“…Although these standards apply in primary care, some studies have shown that standards are often not met in primary care ( 11 , 12 ). However, in studies of patients with asthma and/or chronic obstructive pulmonary disease (COPD), office spirometry was accurate and reliable when compared with laboratory‐based spirometry ( 13 – 15 ), demonstrating that competent operators using equipment that meets ATS/ERS standards can meet the spirometry acceptability criteria in the primary care setting.…”

ERS International Congress, Madrid, 2019: highlights from the Allied Respiratory Professionals' Assembly

“…The role of quality assurance programmes for respiratory physiology testing is regarded as best practice and was the focus of the first talk entitled "What's new in spirometry biological quality control" by B. Thompson (Australia). A review of primary care practice in Australia [9] revealed a lack of understanding of the simplest quality assurance practices and that equipment manufacturers were not promoting calibration syringes for calibration verification checks. Biological quality control (BioQC) testing is also considered best practice, ensuring the quality of results and allowing identification of issues with the equipment and software [10,11].…”

Detecting COPD using micro‐spirometry and/or questionnaire

“…Referral to lung function testing facilities represents another option, but these are not widely available in regional, remote and resource‐poor settings. It should be possible to train individuals in those settings, although this has not been widely adopted.…”

“…Yet, COPD has been uncovered in many settings, with prevalence rates in adults of between 12% and 25%, and it may be time to explore methods and outcomes of detecting COPD at an earlier stage. Pre‐screening (such as using a questionnaire in people aged over 40 years) should enable targeted ‘active’ or ‘opportunistic’ case finding …”