title: Primary care spirometry: test quality and the feasibility and usefulness of specialist reporting.
abstract: BACKGROUND
  Provision of spirometry for chronic obstructive pulmonary disease (COPD) is a new requirement in primary care. Effective spirometry requires that tests and interpretations meet international criteria.
  
  
  OBJECTIVE
  To assess the feasibility and usefulness of remote specialist reporting of primary care spirometry.
  
  
  METHODS
  Comparison of reporting by primary care clinicians and respiratory specialists of consecutive primary care spirometry tests.
  
  
  METHODS
  South London primary care teams with patient lists > or =6000.
  
  
  METHODS
  Feasibility of remote reporting of spirometry was assessed by the frequency of electronic mailing of tests. Usefulness of remote reporting was defined by the frequency that specialist reports made a clinically significant addition. Usefulness was assessed by measuring agreement (kappa) between primary care reports and those of specialists. Clinically significant disagreements were analysed with respect to test quality, diagnosis, and severity.
  
  
  RESULTS
  Six practices emailed 312 tests over 3 months. Forty-nine tests sent without indices or curves (flow volume and time volume) were excluded. Mean age of patients tested was 65 years and 52% were female. Mean predicted forced expiratory volume in the first second (FEV1) was 69%. Clinically significant disagreements were identified in the interpretation of acceptability (quality) of 67/212 (32%) tests (kappa = 0.07; 95% confidence interval [CI] = 0 to 0.24), of diagnosis in 49/168 (29%) tests (kappa = 0.39; 95% CI = 0.25 to 0.55), and of severity in 62/191 (32%) tests (kappa = 0.53; 95% CI = 0.43 to 0.63).
  
  
  CONCLUSIONS
  Remote reporting of primary care spirometry was feasible. Its usefulness was confirmed by the high rate of additional clinically significant information to the reports of primary care clinicians. The quality of primary care spirometry was so unsatisfactory that remote reporting of tests may be a means of establishing adequate spirometry.
authors.affiliation: King's College London Medical School, Department of General Practice and Primary Care, London. patrick.white@kcl.ac.uk
authors.forename: Patrick
authors.initials: P
authors.lastname: White
authors.forename: Wun
authors.initials: W
authors.lastname: Wong
authors.forename: Tracey
authors.initials: T
authors.lastname: Fleming
authors.forename: Barry
authors.initials: B
authors.lastname: Gray
mesh_terms: D000368:Aged; D002983:Clinical Competence / Q000592:standards*; D034742:Electronic Mail; D005194:Family Practice / Q000592:standards*; D005240:Feasibility Studies; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008131:London; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000503:physiopathology; D011787:Quality of Health Care / Q000592:standards; D019114:Remote Consultation / Q000592:standards*; D012720:Severity of Illness Index; D013147:Spirometry / Q000592:standards*; D014797:Vital Capacity / Q000502:physiology