ABSTRACT
OBJECTIVE: To investigate the use and interpretation of spirometry in primary care (PC) in the diagnosis of chronic obstructive pulmonary disease (COPD) and to identify the treatment schedules administered. METHODS: An observational study was performed in a randomized sample of 251 PC physicians including 2130 patients with COPD. Data on the performance of spirometry and the results and the treatment administered were collected as were sociodemographic and clinical data. RESULTS: Spirometric results were obtained in 1243 (58.4%). Most (1118/1243; 89.9%) corresponded to FEV1 (%) values with a mean of 57% (SD=21.5%). It is of note that only 31.8% of spirometric results provided post-bonchodilator results, and 42.9% and 43.1% of the spirometries presented not plausible FVC or FEV1 values, respectively. Treatment varied greatly, with more than 3 drugs being prescribed in 30.6% of the cases. Long-acting beta-2 agonists and inhaled corticosteroids were prescribed in more than 50% of the patients. Tiotropium was administered in 32.4%. According to the GOLD guidelines, 22.8% of the patients in GOLD II, 50% in III and 66.7% in IV were receiving incorrect treatment. CONCLUSIONS: Only 58.4% of the cases included had undergone spirometry. Important deficiencies were observed in the interpretation of the results of spirometry. These difficulties may influence the low implementation of treatment guidelines in COPD in PC.
Subject(s)
Practice Patterns, Physicians'/statistics & numerical data , Pulmonary Disease, Chronic Obstructive/diagnosis , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Primary Health Care , Pulmonary Disease, Chronic Obstructive/drug therapy , Spain , SpirometryABSTRACT
OBJECTIVE: The aim of this study was to assess the use of spirometry for the diagnosis and follow-up of patients with chronic obstructive pulmonary disease (COPD) in primary care in terms of deficiencies and the requirements for its correct use, and to identify the regimens most commonly used in patients with COPD. METHODS: The study included 839 primary care physicians, each of whom completed 2 questionnaires, one on treatment of COPD and the other on the use of spirometry for diagnosis and follow-up of the disease. RESULTS: Notable among the results was the high number of questionnaires in which no response was given to the question on classification of patients according to the severity of airway obstruction (10.7% of cases) and the low number of correct responses to questions on treatment with bronchodilators during the stable phase of COPD (15.1%). The highest rate of correct responses was for questions regarding the indication for spirometry, all of which were answered correctly in more than 60% of cases. Only 59.2% of primary health care centers performed spirometry, mainly due to a lack of training. In more than 30% of cases the nursing staff had not received specific training, a finding that was reflected in the poor compliance with guidelines for calibration (10.9% of health care centers performed daily calibrations), cleaning of the spirometer (in 13.9% of cases the equipment was never cleaned), and providing patients with pretest recommendations (30% did not provide recommendations the day before spirometry). CONCLUSIONS: Primary care physicians are aware of the usefulness of spirometry for the diagnosis and follow-up of COPD. Although they are able to recognize airflow obstruction, they do not classify patients correctly in terms of severity. Very limited availability of spirometry was observed in primary health care centers and there was little training in the use of the technique, a finding reflected in the poor compliance with guidelines for its use.
Subject(s)
Pulmonary Disease, Chronic Obstructive/diagnosis , Humans , Physicians, Family , Practice Patterns, Physicians' , Primary Health Care , Spirometry , Surveys and QuestionnairesABSTRACT
Objetivo: El objetivo del estudio ha sido evaluar las deficiencias y necesidades para la correcta utilización de la espirometría en el diagnóstico y seguimiento del paciente con enfermedad pulmonar obstructiva crónica (EPOC) en atención primaria (AP) y conocer las pautas habituales de tratamiento de esta enfermedad. Métodos: Participaron 839 médicos de AP y cada uno de ellos cumplimentó 2 cuestionarios, uno sobre el tratamiento de la EPOC y otro de utilización de la espirometría en su diagnóstico y seguimiento. Resultados: Destacó el bajo índice tanto de respuestas a la pregunta sobre la clasificación de los pacientes en función de la gravedad de la obstrucción (no respondió el 10,7%) como de respuestas correctas en las preguntas sobre el tratamiento broncodilatador en fase estable (respuestas correctas: 15,1%). Las mayores tasas de respuestas correctas se obtuvieron en las preguntas referentes a la indicación de la espirometría, todas ellas con un índice de acierto superior al 60%. Sólo un 59,2% de los centros de AP realizaban espirometrías, sobre todo debido a la falta de formación. En más de un 30% de los casos el personal de enfermería no había recibido formación específica, lo que se reflejaba en un escaso seguimiento de las normativas en cuanto a calibración (un 10,9% de los centros la realizaba diariamente), limpieza de los aparatos (un 13,9% no la hacía nunca) y recomendaciones al paciente (un 30% no daba recomendaciones el día antes). Conclusiones: Los médicos de AP conocen la utilidad de la espirometría en el diagnóstico y seguimiento de la EPOC. Identifican la presencia de una obstrucción al flujo aéreo, pero no se clasifica correctamente a los pacientes en función de su gravedad. Se ha observado una escasa disponibilidad de la espirometría en los centros de AP, así como una escasa formación en su manejo, lo que se refleja en un escaso seguimiento de las normativas de realización de la prueba
Objective: The aim of this study was to assess the use of spirometry for the diagnosis and follow-up of patients with chronic obstructive pulmonary disease (COPD) in primary care in terms of deficiencies and the requirements for its correct use, and to identify the regimens most commonly used in patients with COPD. Methods: The study included 839 primary care physicians, each of whom completed 2 questionnaires, one on treatment of COPD and the other on the use of spirometry for diagnosis and follow-up of the disease. Results: Notable among the results was the high number of questionnaires in which no response was given to the question on classification of patients according to the severity of airway obstruction (10.7% of cases) and the low number of correct responses to questions on treatment with bronchodilators during the stable phase of COPD (15.1%). The highest rate of correct responses was for questions regarding the indication for spirometry, all of which were answered correctly in more than 60% of cases. Only 59.2% of primary health care centers performed spirometry, mainly due to a lack of training. In more than 30% of cases the nursing staff had not received specific training, a finding that was reflected in the poor compliance with guidelines for calibration (10.9% of health care centers performed daily calibrations), cleaning of the spirometer (in 13.9% of cases the equipment was never cleaned), and providing patients with pretest recommendations (30% did not provide recommendations the day before spirometry). Conclusions: Primary care physicians are aware of the usefulness of spirometry for the diagnosis and follow-up of COPD. Although they are able to recognize airflow obstruction, they do not classify patients correctly in terms of severity. Very limited availability of spirometry was observed in primary health care centers and there was little training in the use of the technique, a finding reflected in the poor compliance with guidelines for its use
