title: Determinants of spirometry use and accuracy of COPD diagnosis in primary care.
abstract: BACKGROUND
  It is unclear if primary care physicians are following guidelines or using other patient characteristics and factors to determine when to perform spirometry in patients at risk for COPD. It is also unclear to what degree a diagnosis of COPD is accurately reflected by spirometry results.
  
  
  OBJECTIVE
  To examine characteristics associated with use of spirometry in primary care for patients with increased risk for COPD and to determine the accuracy of COPD diagnosis in patients with spirometry.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  A cohort that met the following criteria was identified: ≥35 years of age; ≥ 2 primary care visits in internal medicine clinic in 2007; at least one respiratory or smoking cessation medication, or diagnosis of COPD or shortness of breath or dyspnea in 2007.
  
  
  METHODS
  Medical records of all primary care physician visits prior to the time of inclusion in 2007 were reviewed. Data on patient demographics, co-morbidities, respiratory medication use, presence of symptoms, history of tobacco use, and pulmonary function tests were extracted.
  
  
  RESULTS
  A total 1052 patients were identified. Dyspnea on exertion (Adjusted odds ratio (AOR) 1.52 [95% CI 1.06-2.18]) and chronic cough (AOR 1.71 [1.07-2.72]) were the only chronic symptoms associated with use of spirometry. Current (AOR 1.54 [0.99-2.40]) or past smoking (AOR 1.09 [0.72-1.65]) status were not associated with use of spirometry. Of the 159 patients with a diagnosis of COPD, 93 (58.5%) met GOLD criteria and 81(50.9%) met lower limit of normal (LLN) criteria for COPD.
  
  
  CONCLUSIONS
  Clinicians use spirometry more often among patients with symptoms suggestive of COPD but not more often among patients with current or past tobacco use. For patients who had a spirometry and a diagnosis of COPD, primary care physicians were accurate in their diagnosis only half of the time.
authors.affiliation: Section of Pulmonary, Critical Care, Sleep and Allergy Medicine, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA. joo@uic.edu
authors.forename: Min J
authors.initials: MJ
authors.lastname: Joo
authors.forename: David H
authors.initials: DH
authors.lastname: Au
authors.forename: Marian L
authors.initials: ML
authors.lastname: Fitzgibbon
authors.forename: Joanne
authors.initials: J
authors.lastname: McKell
authors.forename: Todd A
authors.initials: TA
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D016001:Confidence Intervals; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000453:epidemiology; D011787:Quality of Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013147:Spirometry / Q000295:instrumentation / Q000706:statistics & numerical data; D013997:Time Factors; D014481:United States / Q000453:epidemiology