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Conducting Respiratory Oscillometry in an Outpatient Setting

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Spirometry expert support in family practice: a cluster-randomised trial.

Patrick J P Poels¹, Tjard R J Schermer, Bart P A Thoonen

¹Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. p.poels@kpnplanet.nl

Primary Care Respiratory Journal : Journal of the General Practice Airways Group

|August 4, 2009

Summary

Expert support for spirometry did not significantly alter family physicians' diagnoses or management plans for respiratory conditions. Neither chest physician nor software interpretation improved clinical decision-making compared to usual care.

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Area of Science:

Pulmonary Medicine
Primary Care
Health Informatics

Background:

Spirometry is crucial for diagnosing respiratory diseases.
Family physicians (FPs) manage many patients with apparent respiratory conditions.
The impact of expert support on FP interpretation of spirometry is not well-established.

Purpose of the Study:

To evaluate the effect of two types of expert spirometry support on FPs' diagnostic accuracy and management strategies.
To compare chest physician interpretation and expert software support against usual care for FPs.

Main Methods:

A cluster-randomised trial involving 44 family practices and 868 patients.
FPs recorded diagnoses and management plans before and after spirometry.
Interventions included support from a chest physician or expert software, compared to usual care.

Main Results:

Diagnosis changes occurred in 47.8% (chest physician), 45.0% (software), and 53.3% (usual care) of cases.
No statistically significant differences in diagnosis changes were observed between intervention groups and usual care.
Secondary outcomes, including referral rates and further testing, also showed no significant differences.

Conclusions:

Neither chest physician nor expert software spirometry support significantly impacted FPs' diagnostic decisions for respiratory conditions.
Current expert support systems do not demonstrably improve clinical management in primary care settings.
Further research may be needed to optimize spirometry interpretation support tools for family physicians.