[Accuracy of spirometry performed by general practitioners and pulmonologists in Pomeranian Region in the "Prevention of COPD" NHS program].
BACKGROUND
Spirometry is the key test in diagnosing and severity assessment of chronic obstructive pulmonary disease (COPD). Despite the simplicity of the test, the discrepancy between results obtained by general practitioners and specialists is noted, what may lead to under- or overestimating of COPD prevalence. The aim of the study was to evaluate the quality of spirometry testing and interpretation performed by general practitioners and pulmonologists.


METHODS
Physicians from 56 healthcare units in the region of Pomerania were included. The participants (both GPs and pulmonologists) were trained in methodology and interpretation of spirometry tests. Then they were asked to choose 10 spirograms and send them for evaluation. Presence of patients' personal details and signature of staff member, contents of graphs and tables, accuracy of the test and correctness of interpretation were evaluated. In statistical analysis c-square test was used.


RESULTS
The response from 14 healthcare units was received including 142 spirograms from GPs and 80 from pulmonologists. All spirograms contained personal details, gender, age, body weight and height as well as results of spirometry in form of tables and diagrams with predicted and measured values. Pulmonologists signed the spirograms more often than GPs (91% v. 77%, p<0.001) and more often presented results of properly performed tests (75% v. 45%, p<0.0001). However, in their group there were more interpretation errors (73% v. 91%, p<0.05). Methodological mistakes revealed during the study were usually: too short and not enough dynamic inspiration and expiration. In some cases spirograms with expiration lasting 1.3 sec were considered normal. The most common interpretation mistakes included: diagnosis of mixed-type ventilatory defects, wrong classification of obstruction level and lack of interpretation. In two cases result was found to be normal despite the lack of forced expiratory volume in one second value.


CONCLUSIONS
The results indicate the necessity of continuous training in spirometry testing and interpretation by both general practitioners and specialists and nurses.
Kuziemski
Krzysztof
K
Klinika Alergologii Gdańskiego Uniwersytetu Medycznego, Gdańsk. k.kuziemski@amg.gda.pl
Słomiński
Wojciech
W
Specjalski
Krzysztof
K
Jassem
Ewa
E
Kalicka
Renata
R
Słomiński
Jan Marek
JM
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003951:Diagnostic Errors / Q000145:classification / Q000517:prevention & control / Q000706:statistics & numerical data*; D005194:Family Practice / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D011044:Poland / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology; D015272:Pulmonary Medicine / Q000379:methods / Q000706:statistics & numerical data*; D036301:Qualitative Research; D011785:Quality Assurance, Health Care; D013147:Spirometry / Q000379:methods / Q000706:statistics & numerical data*; D014797:Vital Capacity