Table 3 Summary of themes on spirometry from focus group discussions with general practitioners in practices receiving the visiting
trained nurse (TN) model or usual care (UC) model of spirometry delivery
| Spirometry theme | TN | UC | Typical examples of statements by a GP |
| High quality essential | Yes | Yes | “It seems quite critical, that the person doing the actual testing is trained, and is aware of patients’ technique” TN model |
| GPs lack time to perform good quality spirometry | No | Yes | “You’d have to use it all the time to get really efficient” UC model |
| Initiation by GPs not required | Yes | No | “I probably wouldn’t be requesting spirometry, unless I already knew there was a problem” TN model |
| Nurse performed spirometry is less threatening for patients | Yes | Yes | Nurses are “not too authoritarian” and are “very non-threatening” TN model |
| Systematic follow-up not achieved | Yes | No | “It is fitted in among whatever is of primary concern to them, and so tends to go to the bottom of the heap” TN model |
| Lack of ownership of test result | Yes | No | “If I order a test I have some obligation to follow-up the results and discuss it with the patient” TN model |
| Use in differential diagnosis | Yes | Yes | “I am looking for a reason why they are short of breath” UC model |
| Emphasis on clinical basis for diagnosis of respiratory disease | Yes | Yes | “You can support what you already know, she is developing a respiratory problem with her smoking” TN model |
| Usefulness of recording a diagnosis of COPD | Yes | Yes | “If you give them a label or not, I think it depends on what impression you give of how serious it actually seems to be, rather than just a label.” TN model |
| Classifying the severity of COPD | Yes | Yes | “Well it helps you in making a diagnosis and helps you to quantify the degree of damage” TN model |
| Objective measurement useful in future | Yes | No | “Same as with hypertension, you have got a baseline of respiratory function” TN model |
| Identifying and recording smoking status | Yes | Yes | “I have identified a few patients who I didn’t know were smokers. I always thought I could smell them” UC model“I have been unaware they are smokers, or even ex-smokers” TN model |
| Discussing smoking cessation | Yes | Yes | “It is an entry into talking about how to give up” TN model |
| Personalise quit advice | Yes | Yes | “You could say that if she stopped smoking there is a good chance she won’t get any worse” UC model |
| Cost a disincentive without appropriate funding | Yes | Yes | “Unless you are doing full lung function, you can’t claim anything” UC model |
