Primary care spirometry: test quality and the feasibility and usefulness of specialist reporting

White, Patrick; Wun Wong; Fleming, Tracey; Gray, Barry
September 2007
British Journal of General Practice;Sep2007, Vol. 57 Issue 542, p701
Academic Journal
Background Provision of spirometry for chronic obstructive pulmonary disease (COPD) is a new requirement in primary care. Effective spirometry requires that tests and interpretations meet international criteria. Aim To assess the feasibility and usefulness of remote specialist reporting of primary care spirometry. Design of study Comparison of reporting by primary care clinicians and respiratory specialists of consecutive primary care spirometry tests. Setting South London primary care teams with patient lists ≥6000. Method Feasibility of remote reporting of spirometry was assessed by the frequency of electronic mailing of tests. Usefulness of remote reporting was defined by the frequency that specialist reports made a clinically significant addition. Usefulness was assessed by measuring agreement (κ) between primary care reports and those of specialists. Clinically significant disagreements were analysed with respect to test quality, diagnosis, and severity. Results Six practices emailed 312 tests over 3 months. Forty-nine tests sent without indices or curves (flow volume and time volume) were excluded. Mean age of patients tested was 65 years and 52% were female. Mean predicted forced expiratory volume in the first second (FEV1) was 69%. Clinically significant disagreements were identified in the interpretation of acceptability (quality) of 67/212 (32%) tests (κ = 0.07; 95% confidence interval [CI] = 0 to 0.24), of diagnosis in 49/168 (29%) tests (κ = 0.39; 95% CI = 0.25 to 0.55), and of severity in 62/191 (32%) tests (κ = 0.53; 95% CI = 0.43 to 0.63). Conclusion Remote reporting of primary care spirometry was feasible. Its usefulness was confirmed by the high rate of additional clinically significant information to the reports of primary care clinicians. The quality of primary care spirometry was so unsatisfactory that remote reporting of tests may be a means of establishing adequate spirometry.


Related Articles

  • Spirometry: an essential tool for screening, case-finding, and diagnosis of COPD. Sims, Erika J.; Price, David // Primary Care Respiratory Journal;Jun2012, Vol. 21 Issue 2, p128 

    An introduction is presented in which the editor discusses various reports within the issue on topics including the usefulness and cost-effectiveness in providing pre-standard spirometry for chronic obstructive pulmonary disease (COPD) case-finding, the accuracy of asthma and COPD diagnosis in...

  • Spirometry performance in primary care: the problem, and possible solutions. Jenkins, Christine // Primary Care Respiratory Journal;Sep2009, Vol. 18 Issue 3, p128 

    The author reflects on the spirometry performance in primary care. The author delineates the significance of spirometry which include the accuracy in diagnosing obstructive lung disease, ruling out significant airways disease and avoiding overdiagnosis. An overview of the Standards Document on...

  • Piloting tele-monitoring in COPD: a mixed methods exploration of issues in design and implementation. Ure, Jenny; Pinnock, Hilary; Hanley, Janet; Kidd, Gillian; Smith, Emily McCall; Tarling, Alex; Pagliari, Claudia; Sheikh, Aziz; MacNee, William; McKinstry, Brian // Primary Care Respiratory Journal;Mar2012, Vol. 21 Issue 1, p57 

    Background: In 2008 NHS Lothian implemented a COPD tele-monitoring service incorporating a touch-screen computer for daily recording of symptoms and weekly oximetry and spirometry measurement. Data were transmitted by secure broadband link to a call centre where trained workers monitored data...

  • Symptom-Based Questionnaire for Differentiating COPD and Asthma. Tinkelman, David G.; Price, David B.; Nordyke, Robert J.; Halbert, R. J.; Isonaka, Sharon; Nonikov, Dmitry; Juniper, Elizabeth F.; Freeman, Daryl; Hausen, Thomas; Levy, Mark L.; Østrem, Anders; Van der Molen, Thys; Van Schayck, Constant P. // Respiration;2006, Vol. 73 Issue 3, p296 

    Background: Many patients with obstructive lung disease (OLD) carry an inaccurate diagnostic label. Symptom-based questionnaires could identify persons likely to need spirometry. Objectives: We prospectively tested questions derived from a comprehensive literature review and an international...

  • Evaluation of patients with symptoms of chronic lung disease in primary care. Marks, Guy B. // Primary Care Respiratory Journal;Jun2013, Vol. 22 Issue 2, p145 

    The author reflects on the diagnosis of chronic obstructive pulmonary disease (COPD) in a primary care setting. He cites a study by B. Lamprecht and colleagues which highlights the failure in diagnosing and identifying patients with COPD. He says that the study also demonstrates the problem on...

  • Importance of primary care. R.M.D. // Cortlandt Forum;9/25/96, Vol. 9 Issue 9, p140 

    Discusses the importance of seeing a primary care physician rather than use self-referral to a specialist. Specialists' assumption that a primary-care physician has already checked the urine and found it to be normal.

  • Poster 32 Is It Important to Stretch Accessory Inspiratory Muscles? A Case Series. Pleguezuelos, Eulogio; Bobadilla, Mirta; Costea, Maria; Guirao, Lluis; Llorensi, Gemma; Perez, Maria Engracia; Samitier, Beatriz // PM & R: Journal of Injury, Function & Rehabilitation;Sep2011 Supplement, Vol. 3 Issue 10S, pS187 

    No abstract available.

  • Spirometry in primary care for case finding and management of chronic obstructive pulmonary disease. Parkes, Gary; Plüddemann, Annette; Heneghan, Carl; Price, Christopher P.; Wolstenholme, Jane; Thompson, Matthew // British Journal of General Practice;Nov2011, Vol. 61 Issue 592, p698 

    The article discusses a study on the use of pulse oximetry in primary care for chronic obstructive pulmonary disease (COPD) diagnosis or to help decision making during exacerbation. It characterizes COPD as a progressive, largely irreversible, obstruction to airflow whose severity is classified...

  • FEV6 as screening tool in spirometric diagnosis of obstructive airway disease. Malolan, P. Adithya; Acharya, Vishak; Unnikrishnan, B. // Lung India;Apr-Jun2010, Vol. 27 Issue 2, p63 

    Context: The use of spirometry is currently limited to the diagnosis of obstructive airway disease for tertiary centers mainly because of the unmet need for technical expertise and funding. Use in primary care asks for a simpler and cost-effective screening tool for obstructive airway disease....

  • Spirometry in primary care case-identification, diagnosis and management of COPD. Price, David; Crockett, Alan; Arne, Mats; Garbe, Bernard; Jones, Rupert; Kaplan, Alan; Langhammer, Arnulf; Williams, Siân; Yawn, Barbara // Primary Care Respiratory Journal;Sep2009, Vol. 18 Issue 3, p216 

    Chronic obstructive pulmonary disease (COPD) is an important cause of morbidity and mortality worldwide, yet it remains significantly under-diagnosed. Systematic and opportunistic case-identification efforts in primary care, using questionnaires, careful assessment to identify symptoms, and...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics