Patient and physician factors associated with pulmonary function testing for COPD: a population study

Area of Science:

• Pulmonary Medicine
• Health Services Research
• Epidemiology

Background:

• Diagnosis of Chronic Obstructive Pulmonary Disease (COPD) requires objective demonstration of nonreversible airflow obstruction.
• Pulmonary function testing (PFT) is the standard for diagnosis, yet its utilization rates remain low.
• The reasons for underutilization of PFT in COPD diagnosis are not well understood.

Purpose of the Study:

• To investigate the rates of PFT use in newly diagnosed COPD patients in Ontario, Canada.
• To identify patient demographic, clinical, and healthcare system factors associated with PFT receipt.
• To explore the influence of primary care physician characteristics on PFT ordering for COPD diagnosis.

Main Methods:

• Population-based study utilizing health administrative data from Ontario, Canada (2000-2010).
• Included individuals aged 35+ newly diagnosed with COPD.
• Analyzed PFT receipt during the peridiagnostic period (1 year before to 1 year after diagnosis) in relation to patient and physician factors.

Main Results:

• Only 35.9% of 491,754 individuals newly diagnosed with COPD received PFT.
• Lower PFT rates were observed in younger (<50) and older (>80) patients, those in long-term care, and those with stroke or dementia.
• Higher PFT rates were associated with specialist involvement and coexisting pulmonary disease; older physicians were less likely to order PFT.

Conclusions:

• Approximately one-third of individuals with COPD in Ontario received PFT for diagnosis confirmation.
• Patient age, comorbidities, and physician-related factors significantly influence PFT utilization.
• Targeted interventions addressing these factors are crucial to enhance appropriate PFT use and improve COPD care quality.