Introduction Spirometric testing in primary care is promoted by the QoF for GPs. The validity of such tests is questionable, due to numerous factors, including poor technique, machine maintenance and interpretive skills. The COPD Strategy supports the use of quality-assured spirometry in primary care. This study assesses the accuracy of primary care-based spirometry in referrals to our chest clinic and new Direct Access Pulmonary Function service.
To validate GP spirometry values with Secondary care values.
To identify differences in diagnosis based on physiological measurements.
To identify changes in severity status on COPD patients.
Method An audit was conducted, comparing Spirometry performed in Primary care (various machines and various technicians) with Spirometry performed on the Masterscreen PFT (CareFusion) in Lung Function laboratory. Where appropriate, obstructive spirometry was classified using GOLD/NICE COPD guidelines.
Results 37 patients identified.
No Spirometry results from GP = 4 (11%)
No change = 17 (46%)
Changed = 16 (43%)
Of the 16 that had their diagnosis changed:
5 (31%) classified as restrictive on referral, but were normal
4 (25%) classified obstructive on referral, but were normal
7 (44%) classified as normal on referral, but were obstructive
Of all referrals which were classified as obstructive (22 patients), 64% had their GOLD severity changed:
8 maintained their severity as classified by GP spirometry (36%)
8 changed by 1 GOLD stage (36%)
6 changed 2 GOLD stages (27%)
Conclusion For patients with COPD, the cost in treating patients varies with their disease severity. A change in severity staging would significantly alter the cost of treatment for Primary Care, by influencing the appropriate choice of treatment interventions. Correct diagnosis in primary care is fundamental to appropriate treatment and referral pathways for patients with respiratory disease. This study identifies a significant difference in physiological diagnosis achieved in secondary care and supports the need for more quality-assured pulmonary function testing.
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