Comparison of a network of primary care physicians and an open spirometry programme for COPD diagnosis.
BACKGROUND
Early diagnosis of Chronic Obstructive Pulmonary Disease (COPD) remains the cornerstone for effective management. In this study we compared an open spirometry programme and a case-finding programme providing spirometry to high-risk subjects selected by primary care physicians.


METHODS
A network of primary care physicians was created after invitation and all participants received training on COPD and spirometry. The study team visited 12 primary care settings in each programme in a 1-year period. Spirometry was performed in all eligible participants. COPD diagnosis and classification was based on GOLD guidelines and evaluation by a chest physician.


RESULTS
Patients with acceptable spirometry were evaluated (n = 201 in the case-finding and n = 905 in the open spirometry programme). The proportion of newly diagnosed COPD was 27.9% in the case-finding programme compared to 8.4% in the open spirometry programme (p < 0.0001). The number needed-to-screen (NNS) for a new diagnosis of COPD was 3.6 in the case-finding programme compared to 11.9 in the open spirometry programme. The majority of newly diagnosed patients were classified in GOLD stages I an II. The average cost for a new diagnosis of COPD was 173 € in the open spirometry programme and 102 € in the case-finding programme.


CONCLUSIONS
A case-finding programme involving primary care physicians was more cost-effective for the identification of new cases of COPD compared to an open spirometry programme. The development of networks of primary care physicians with access to good quality spirometry and specialist consultation for early diagnosis of COPD is justified.
Konstantikaki
Vaya
V
Respiratory Medicine Department, University of Thessaly Medical School, Larissa, Greece.
Kostikas
Konstantinos
K
Minas
Markos
M
Batavanis
Georgios
G
Daniil
Zoe
Z
Gourgoulianis
Konstantinos I
KI
Hatzoglou
Chrissi
C
D001993:Bronchodilator Agents / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D042241:Early Diagnosis; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058007:Physicians, Primary Care; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy; D013147:Spirometry; D011795:Surveys and Questionnaires
D001993:Bronchodilator Agents