General practice spirometry in North Staffordshire.
Spirometry is suggested, in North American and European guidelines, to be the most important measurement of lung function for the management of patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to determine attitudes to and utilization of spirometry in general practices within North Staffordshire. All 95 practices in North Staffordshire were surveyed by telephone, using a standard proforma. Eighty-four practices (48 fundholding) containing 224 general practitioners (GPs) and serving 472,420 patients, agreed to take part. The survey was completed by practice nurses on 63 occasions, GPs on 14 and practice managers on seven. Eighteen practices possessed a spirometer, although eight did not use it. The measurements were performed by doctors in five of the practices, nurses in two and by both in three. Only two users had received formal training in the performance and interpretation of spirometry. Of the three practices using pneumotachograph spirometers, none knew how often the machine should be calibrated. Spirometry was used by five practices for diagnosis (although only four used it to determine forced expiratory volume in one second (FEV1)), three for monitoring and only one for bronchodilator reversibility testing. Although 44 (52%) practices thought that, ideally, spirometry should be available in the practice, only 10 of the 18 who had spirometers were currently providing this facility. Furthermore, the poor training puts into question the validity of some of the results obtained. Open access to hospital spirometry is one method of addressing these problems, and 73 (87%) practices, including 16 who already owned a spirometer, said that they would use such a service.
Dept of Respiratory Medicine, City General Hospital, North Staffordshire Hospital NHS Trust, Stoke-on-Trent, UK.
L J
LJ
Dowson
A
A
Yeung
M B
MB
Allen
D003625:Data Collection; D005194:Family Practice / Q000379:methods*; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000175:diagnosis*; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013147:Spirometry / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D006113:United Kingdom