title: Does spirometry training in general practice improve quality and outcomes of asthma care?
abstract: OBJECTIVE
  Clinical asthma guidelines recommend spirometry for asthma diagnosis, but there is inconsistent evidence about benefits to patients in using it for ongoing management. Our aim was to determine whether training in the use of spirometry for management of asthma provided better health outcomes and improved the quality of care in the primary care setting.
  
  
  METHODS
  Pragmatic, cluster randomized controlled trial.
  
  
  METHODS
  General practices in two states of Australia.
  
  
  METHODS
  Forty practices and 397 adults with asthma.
  
  
  METHODS
  The staff of 26 intervention practices received comprehensive spirometry training. Fourteen control practices provided usual care.
  
  
  METHODS
  Primary outcome measures were quality of life, self-reported asthma symptoms and lung function. Secondary measures related to the process of care (e.g. performance of spirometry, preparation of a written asthma action plan) and patient and general practitioner rating of the acceptability and usefulness of spirometry.
  
  
  RESULTS
  There were no statistically significant differences between the groups at 12 months for quality of life (mean difference = -0.23; 95% CI: -0.44, -0.01), days off work (rate ratio = 1.52; 95% CI: 0.91, 2.54), exacerbations (rate ratio = 1.09; 95% CI: 0.85, 1.41), asthma on waking (rate ratio = 1.21; 95% CI: 0.79, 1.85), nocturnal asthma (rate ratio = 0.98; 95% CI: 0.63, 1.51) and post-bronchodilator FEV(1)/FVC ratio (mean difference = -0.01, 95% CI: -0.03, 0.02). There was no improvement in the quality of care provided.
  
  
  CONCLUSIONS
  Training in spirometry did not result in any measurable improvement in the use of spirometry, quality of management of asthma or patient outcomes in primary care.
authors: Primary Care Respiratory Research Unit, Discipline of General Practice, School of Population Health and Clinical Practice, The University of Adelaide, Adelaide, South Australia 5005, Australia. christine.holton@adelaide.edu.au
authors: Christine
authors: C
authors: Holton
authors: Alan
authors: A
authors: Crockett
authors: Mark
authors: M
authors: Nelson
authors: Philip
authors: P
authors: Ryan
authors: Richard
authors: R
authors: Wood-Baker
authors: Nigel
authors: N
authors: Stocks
authors: Nancy
authors: N
authors: Briggs
authors: Justin
authors: J
authors: Beilby
mesh_terms: D001249:Asthma / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D019983:Guideline Adherence; D006282:Health Personnel / Q000193:education*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods* / Q000592:standards; D011788:Quality of Life; D012648:Self Care / Q000379:methods*; D018434:Sickness Impact Profile; D013021:South Australia; D013147:Spirometry / Q000379:methods* / Q000592:standards; D013648:Tasmania; D000078329:Workforce