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A mixed methods study to compare models of spirometry delivery in primary care for patients at risk of Chronic Obstructive Pulmonary Disease
  1. Julia A Walters (jaew{at}utas.edu.au)
  1. Menzies Research Institute, University of Tasmania, Australia
    1. Emily C Hansen (emily.hansen{at}utas.edu.au)
    1. PHCRED Unit, Menzies Research Institute, University of Tasmania, Australia
      1. David P Johns (david.johns{at}utas.edu.au)
      1. Menzies Research Institute, University of Tasmania, Australia
        1. E. Haydn Walters (haydn.walters{at}utas.edu.au)
        1. Menzies Research Institute, University of Tasmania, Australia
          1. Leigh Blizzard (leigh.blizzard{at}utas.edu.au)
          1. Menzies Research Institute, University of Tasmania, Australia
            1. Richard Wood-Baker (richard.woodbaker{at}utas.edu.au)
            1. Menzies Research Institute, University of Tasmania, Australia

              Abstract

              Background: To increase recognition of airflow obstruction in primary care, we compared two models of spirometry delivery for a target group, namely smokers and ex-smokers aged over 35.

              Methods: A 6 month qualitative/quantitative cluster randomised study in 8 practices compared opportunistic spirometry by "visiting trained nurses" (TN) with optimised "usual care"(UC) from GPs. Outcomes were: spirometry uptake and quality, new diagnoses of Chronic Obstructive Pulmonary Disease (COPD) and GPs' experiences of spirometry models.

              Results: In the eligible target population, 531/904 (59%) patients underwent spirometry in the TN model and 87/1,130 (8%) patients in the UC model (p<0.0001). ATS spirometry standards for acceptability and reproducibility were met by 76% and 44% of tests in the TN and UC models respectively (p<0.0001). 125 (24%) patients tested with the TN model and 38 (68%) with the UC model reported a pre-existing respiratory diagnosis (p<0.0001). In patients with demonstrated airflow obstruction, 3 months after spirometry doctor-recorded COPD increased by 8% (to 19%) in practices with the TN model and by 9% (to 42%) in practices with the UC model, while 60% and 29% respectively had no doctor-recorded diagnosis of either asthma or COPD (p<0.0001). GPs valued the high quality spirometry testing in patients at risk of COPD in the TN model. They identified limitations, including the need for systematic follow up and support with spirometry interpretation, which may explain persistent under-diagnosis of COPD found in practice records.

              Conclusions: Although opportunistic testing by visiting trained nurses substantially increased and improved spirometry performance compared to usual care, translating increased detection of airflow obstruction into diagnosis of COPD requires further development of the model.

              Trial Registration Australian Clinical Trials Registry: registration number 12605000019606

              • Chronic Obstructive Pulmonary Disease
              • Diagnosis
              • Primary health care
              • Qualitative research
              • Spirometry

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