title: Use of spirometry in the diagnosis of COPD: a qualitative study in primary care.
abstract: Guidelines that recommend spirometry to confirm airflow obstruction among patients with suspected COPD are not routinely followed. We conducted a qualitative study to identify attitudes and barriers of primary care physicians to performing spirometry for patients with possible COPD. We conducted four focus groups, each with three primary care physicians (PCPs) who practice in an urban, academic medical center. In general, PCPs believed that spirometry was not necessary to confirm the diagnosis of COPD. Compared to other co-morbid conditions, in a patient with a diagnosis of COPD without self-reported symptoms, COPD was not a priority during a clinic visit. This was in part due to the belief that there was lack of evidence that medication used in COPD lead to improved outcomes and that there was no point of care measure for COPD compared to other co-morbid conditions such as diabetes mellitus or hypertension. Health system barriers specific to spirometry use was not identified. In conclusion, in our sample of PCPs, there was skepticism that spirometry is warranted to diagnose and manage COPD. Availability of spirometry was not a perceived barrier. Our results explain, in part, why previous interventions to improve access to spirometry and diagnosis of COPD in primary care settings have been difficult to conduct and/or have had marginal success. Our findings strongly suggest that a first step toward increasing the use of spirometry among primary care physicians is to have them believe in its utility in the diagnosis of COPD.
authors.affiliation: Section of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois Hospital and Health Sciences System, Chicago, IL 60612-7323, USA. fgr01m@gmail.com
authors.forename: Min J
authors.initials: MJ
authors.lastname: Joo
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Sharp
authors.forename: David H
authors.initials: DH
authors.lastname: Au
authors.forename: Todd A
authors.initials: TA
authors.lastname: Lee
authors.forename: Marian L
authors.initials: ML
authors.lastname: Fitzgibbon
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D013147:Spirometry / Q000706:statistics & numerical data
references.citation: Aust Fam Physician. 2005 Mar;34(3):201-3
references.pmid: 15799676
references.citation: Chest. 2006 Apr;129(4):844-52
references.pmid: 16608929
references.citation: Respir Care. 2005 Dec;50(12):1639-48
references.pmid: 16318645
references.citation: MMWR Surveill Summ. 2002 Aug 2;51(6):1-16
references.pmid: 12198919
references.citation: Eur Respir J. 2006 Nov;28(5):945-52
references.pmid: 16870668
references.citation: Int J Chron Obstruct Pulmon Dis. 2011;6:171-9
references.pmid: 21468169
references.citation: Chest. 2008 Jul;134(1):38-45
references.pmid: 18347201
references.citation: Respir Med. 2005 Apr;99(4):493-500
references.pmid: 15763457
references.citation: J Asthma. 2006 Jan-Feb;43(1):75-80
references.pmid: 16448970
references.citation: Respir Med. 2008 May;102(5):738-43
references.pmid: 18222684
references.citation: Chest. 2004 Apr;125(4):1394-9
references.pmid: 15078751
references.citation: Thorax. 2008 May;63(5):408-14
references.pmid: 18024537
references.citation: Health Serv Res. 2005 Apr;40(2):477-97
references.pmid: 15762903
references.citation: Arch Intern Med. 2000 Jun 12;160(11):1683-9
references.pmid: 10847262
references.citation: Chest. 2006 Jun;129(6):1509-15
references.pmid: 16778268
references.citation: J Gen Intern Med. 2002 Sep;17(9):684-8
references.pmid: 12220364
references.citation: Am J Med. 2007 Aug;120(8 Suppl 1):S23-7
references.pmid: 17678940
references.citation: JAMA. 2000 Apr 12;283(14):1853-7
references.pmid: 10770147
references.citation: JAMA. 1995 Jan 25;273(4):313-9
references.pmid: 7815660
references.citation: Chest. 1994 Nov;106(5):1427-31
references.pmid: 7956395
references.citation: Scand J Prim Health Care. 1991 Dec;9(4):232-8
references.pmid: 1792447
references.citation: Chest. 2007 Aug;132(2):403-9
references.pmid: 17550936