title: Telepulmonology and telespirometry.
abstract: Taking and interpreting spirometry tests has proven difficult in primary care practice. This may lead to mis- or underdiagnosis of pulmonary diseases, among others chronic obstructive pulmonary disease. Telespirometry and telepulmonology consultation (TPC) may play a role in monitoring and improving the quality of the spirometry tests, supporting GPs in interpreting spirometry test results and reducing the number of physical referrals to the pulmonologist. In telespirometry up to 10% of spirometry results uploaded by GPs were randomly sent to a pulmonologist. Both the GP or practice nurse and the pulmonologist interpreted the spirometry results and gave their diagnostic findings. Additionally the pulmonologist assessed the quality of the test. In TPC a GP could digitally consult a pulmonologist for advice or referral of patients. On sending and closing the TPC consult the GP was presented a number of questions. Based on these questions the percentage of prevented physical referrals and the educational effect experienced by the GPs were determined. Almost a third of the 227 telespirometry tests was of Moderate or Bad quality. The Kappa of the interobserver agreement on diagnostic findings between GP and pulmonologist was 0.38. Between April 2009 and January 2014, GPS sent 4.488 TPCs to pulmonologists. Sixty-nine percent of the TPCs were sent to gain advice, the others were sent in order to prevent a physical referral. Overall telepulmonology reduced the number of physical referrals by 22%. In 90% of the TPCs the GPs indicated they had learned from the consult.
authors.affiliation: KSYOS Health Management Research, Amstelveen, The Netherlands.
authors.forename: Leonie
authors.initials: L
authors.lastname: Thijssing
authors.affiliation: KSYOS Health Management Research, Amstelveen, The Netherlands.
authors.forename: Job
authors.initials: J
authors.lastname: van der Heijden
authors.affiliation: Department of Pulmonology, Spaarne Hospital, Hoofddorp, The Netherlands.
authors.forename: Christian
authors.initials: C
authors.lastname: Melissant
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Niels
authors.initials: N
authors.lastname: Chavannes
authors.affiliation: KSYOS Health Management Research, Amstelveen, The Netherlands.
authors.forename: Leonard
authors.initials: L
authors.lastname: Witkamp
authors.affiliation: Center of Human Factors Engineering of Health Information Technology HITlab, Department of Medical Informatics, Academic Medical Center-University of Amsterdam, The Netherlands.
authors.forename: Monique
authors.initials: M
authors.lastname: Jaspers
mesh_terms: D002983:Clinical Competence / Q000706:statistics & numerical data*; D058006:General Practice / Q000706:statistics & numerical data*; D006801:Humans; D009426:Netherlands; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis*; D015272:Pulmonary Medicine / Q000706:statistics & numerical data*; D019114:Remote Consultation / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013147:Spirometry / Q000706:statistics & numerical data*