title: Determinants of use of the bronchodilator test in primary and secondary care: results of a national survey in Spain.
abstract: OBJECTIVE
  A recent study evaluated the use of spirometry in primary (PC) and secondary care (SC) in Spain. In the present study, we aimed to analyze the determinants of use of the bronchodilator test (BDT) with a special emphasis in the type of drugs used, waiting times and positive test criteria followed.
  
  
  METHODS
  Cross-sectional trial surveying 605 PC and 200 SC centers in Spain. Regarding the BDT, variables collected were: name of the drugs available for the BDT, name of the drug normally used, number of inhalations, waiting time for the second spirometry, staff involved and criteria used for a positive test. Adherence to actual guidelines according to five quality criteria was evaluated.
  
  
  RESULTS
  Although a range of short-acting bronchodilators were used, only 25.9% of centers used a correct dose. The waiting time was correct in 63.7% and 72.8% of PC and SC, respectively (P = 0.023). A threshold higher than 12% and 200 mL to consider a positive test was fulfilled in 55.8% and 52.8% of PC and SC, respectively. Altogether, only 7.6% of PC and 6.0% of SC fulfilled all five quality criteria. Factors identified to be associated with this fulfillment were the number of spirometries per week, not being conducted by a nurse, periodical retraining, training for interpreting and daily calibration.
  
  
  CONCLUSIONS
  The present study identifies determinants of the performance of the BDT in Spain identifying strengths and weaknesses. Health managers should use this information to improve the quality of spirometries in chronic respiratory patients.
authors.affiliation: Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Lopez-Campos
authors.affiliation: Hospital Universitario Son Espases, Fundación de Investigación Sanitaria de las Islas Baleares (FISIB), Palma de Mallorca, Islas Baleares, Spain.
authors.forename: Joan B
authors.initials: JB
authors.lastname: Soriano
authors.affiliation: Servicio de Neumología, Hospital Universitario San Carlos, Madrid, Spain.
authors.forename: Myriam
authors.initials: M
authors.lastname: Calle
mesh_terms: D000280:Administration, Inhalation; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D019983:Guideline Adherence; D006801:Humans; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000706:statistics & numerical data; D015272:Pulmonary Medicine / Q000193:education / Q000379:methods; D012129:Respiratory Function Tests / Q000379:methods / Q000706:statistics & numerical data*; D063127:Secondary Health Care / Q000706:statistics & numerical data; D013030:Spain; D013147:Spirometry / Q000379:methods / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
chemical_list: D001993:Bronchodilator Agents
keywords: bronchodilator test; guidelines; quality; spirometry; variability