title: Variation in spirometry utilization between trained general practitioners in practices equipped with a spirometer.
abstract: OBJECTIVE
  To explore spirometry utilization among general practitioners and identify practitioner and practice-related factors associated with spirometry utilization.
  
  
  METHODS
  Multivariate multilevel cross-sectional analysis of a questionnaire survey.
  
  
  METHODS
  Some 61 general practices involved in a spirometry evaluation programme in the Netherlands. All practices owned a spirometer and were trained to perform spirometry.
  
  
  METHODS
  A total of 144 general practitioners and 179 practice assistants.
  
  
  METHODS
  Extent of spirometry utilization for five indications from national COPD/asthma guidelines, practitioner and practice-related factors associated with spirometry utilization.
  
  
  RESULTS
  The response rate was 97%. General practitioners used spirometry mostly to evaluate treatment with inhaled steroids (58%). Significant practitioner-related factors associated with spirometry utilization were: general practitioners' job satisfaction, general practitioners' general interest in research, and prior participation in spirometry training. Practice-related factors associated with spirometry utilization were: presence of a practice nurse, delegation of medical tasks to practice assistants, use of spirometry in different rooms, and use of protocols in practice.
  
  
  CONCLUSIONS
  Practitioner- as well as practice-related factors were associated with the extent of spirometry utilization. In particular, it is essential to improve practice-related factors (e.g. presence of a practice nurse, more delegation of medical tasks to the practice assistant).
authors.affiliation: Department of General Practice, Radboud University Nijmegen Medical Centre, The Netherlands. p.j.p.poels@haf.umcn.nl
authors.forename: Patrick J P
authors.initials: PJ
authors.lastname: Poels
authors.forename: Tjard R J
authors.initials: TR
authors.lastname: Schermer
authors.forename: Annelies
authors.initials: A
authors.lastname: Jacobs
authors.forename: Reinier P
authors.initials: RP
authors.lastname: Akkermans
authors.forename: Joliet
authors.initials: J
authors.lastname: Hartman
authors.forename: Ben J A M
authors.initials: BJ
authors.lastname: Bottema
authors.forename: Chris
authors.initials: C
authors.lastname: van Weel
mesh_terms: D000328:Adult; D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010818:Practice Patterns, Physicians'; D011331:Private Practice; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D013147:Spirometry / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D000078329:Workforce