Spirometry can be done in family physicians' offices and alters clinical decisions in management of asthma and COPD
ABSTRACT Spirometry is recommended for diagnosis and management of obstructive lung disease. While many patients with asthma and COPD are cared for by primary care practices, limited data are available on the use and results associated with spirometry in primary care.
To assess the technical adequacy, accuracy of interpretation, and impact of office spirometry.
A before-and-after quasiexperimental design.
Three hundred eighty-two patients from 12 family medicine practices across the United States.
Patients with asthma and COPD, and staff from the 12 practices.
Technical adequacy of spirometry results, concordance between family physician and pulmonary expert interpretations of spirometry test results, and changes in asthma and COPD management following spirometry testing.
Of the 368 tests completed over the 6 months, 71% were technically adequate for interpretation. Family physician and pulmonary expert interpretations were concordant in 76% of completed tests. Spirometry was followed by changes in management in 48% of subjects with completed tests, including 107 medication changes (>85% concordant with guideline recommendations) and 102 nonpharmacologic changes. Concordance between family physician and expert interpretations of spirometry results was higher in those patients with asthma compared to those with COPD.
US family physicians can perform and interpret spirometry for asthma and COPD patients at rates comparable to those published in the literature for international primary care studies, and the spirometry results modify care.
- SourceAvailable from: Niels Chavannes
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- "The main reason for disagreement on diagnosis was that COPD was not diagnosed by GPs, while according to international criteria the test results indicated COPD. A study of Yawn et al. likewise found disagreements between GPs and pulmonologists on the interpretation of spirometry results in 88 out of 368 tests (24%) . Most common reasons for disagreement in this study were overreporting of airflow obstruction in patients with normal spirometry results by GPs, interpreting restrictive patterns in people with poor effort and diagnosing COPD in absence of spirometry results indicating COPD. "
ABSTRACT: Interpreting spirometry results has proven challenging in primary care practice, among others potentially leading to under- and misdiagnosis of COPD. In telepulmonology a general practitioner (GP) digitally consults a pulmonologist to support the interpretation of spirometry results. This study assessed the effect of telepulmonology on quality and efficiency of care. Quality of care was measured by five indicators, among others the percentage of TelePulmonology Consultations (TPCs) sent by GPs for advice, percentage of those TPCs resulting in a physical referral, and educational effect of telepulmonology as experienced by GPs. Efficiency was defined as the percentage of prevented unnecessary physical referrals of patients to the pulmonologist. Between April 2009 and November 2012 1.958 TPCs were sent by 158 GPs to 32 pulmonologists. Sixty-nine percent of the TPCs were sent for advice. Based on the advice of the pulmonologist 18% of these TPCs led to a physical referral of patients who would not have been referred without telepulmonology. Thirty-one percent of the TPCs were intended to prevent a physical referral, 68% of these actually prevented a physical referral to a pulmonologist. The results show telepulmonology can contribute to quality of care by supporting GPs and can additionally prevent unnecessary physical referrals.Respiratory medicine 10/2013; 108(2). DOI:10.1016/j.rmed.2013.10.017 · 2.92 Impact Factor
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- "For those with recognized COPD, current management is frequently incompatible with recommended care (ATS 2004; GOLD 2007; NICE 2007) For those who have unrecognized COPD, opportunities to improve their functional status, quality of life, and prevention of exacerbations are missed by failure to recognize the disease (Pena et al 2000; Halbert et al 2003, 2006; Zaas et al 2004; Lindberg et al 2006). Among the barriers that may slow the implementation of evidence-based COPD management are ambiguous and divergent US recommendations for COPD screening (NLHEP 1998; Hardie et al 2002; Bolton et al 2005; Wilt et al 2005; Hansen-Flaschen 2007; Yawn et al 2007). The lack of well recognized US primary care guidelines for the management of diagnosed COPD is another potential barrier to an aggressive primary care approach to COPD. "
ABSTRACT: COPD remains under-recognized and under-treated. Much of early COPD care is given by primary care physicians but only when COPD is recognized. This survey explores the attitudes, beliefs, and knowledge related to COPD recognition, diagnosis, and treatment from family physicians and nurse practitioners (NPs) and physician assistants (PAs) working in primary care. We completed a survey of family physicians, and NPs/PAs attending one of three CME programs on five common chronic conditions including COPD. Return rate was 62% (n = 284) including 178 physicians and 100 NPs/PAs. Fewer than half of the respondents reported knowledge of or use of COPD guidelines. The barriers to recognition and diagnosis of COPD they reported included the multiple morbidities of most COPD patients, failure of patients to report COPD symptoms, as well as lack of knowledge and inadequate training in COPD diagnosis and management. Three quarters (74%) of respondents reported use of spirometry to diagnose COPD but only 32% said they included reversibility assessment. COPD was incorrectly assessed as a disease primarily of men (78% ofrespondents) that appeared after age 60 (61%). Few respondents reported that they believed COPD treatment was useful or very useful for improving symptoms (15%) or decreasing exacerbations (3%) or that pulmonary rehabilitation was helpful (3%), but 13% reported they thought COPD treatment could extend longevity. Primary care physicians and NPs/PAs working in primary care continue to report lack of awareness and use of COPD guidelines, as well as correct information related to COPD epidemiology or potential benefits of available treatments including pulmonary rehabilitation. It is unlikely that diagnosis and management of COPD will improve in primary care until these knowledge gaps and discrepancies with published efficacy of therapy issues are addressed.International Journal of COPD 02/2008; 3(2):311-7. · 2.73 Impact Factor