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Identifying airway obstruction in primary care: is there a role for physiotherapists?
Lisa Pagano1, Sarah Dennis1,2,3, Sally Wootton1,4
1Sydney School of Health Sciences, Faculty of Medicine and Health, Level 7, D18 - Susan Wakil Health Building, The University of Sydney, Camperdown, NSW, 2006, Australia.
Aims:
To examine the implementation of a physiotherapist-driven spirometry case finding service in primary care to identify new cases of COPD and confirm diagnosis of existing cases of COPD.
Methods:
Four general practices were recruited. 'At risk' participants (aged ≥ 40 years, current/ex-smoker) and people with 'existing' COPD were identified from practice databases and invited to attend an assessment with a cardiorespiratory physiotherapist in each general practice. The physiotherapist performed pre/post-bronchodilator spirometry to identify or confirm a diagnosis of COPD (FEV1/FVC < 0.7). Outcome measures included number (%) of new cases of COPD, number (%) confirmed diagnosis of COPD and number (%) of high quality spirometry assessments with accurate interpretation.
Results:
One hundred forty eight participants (mean age 70 years (SD 11.1), 57% female) attended a baseline assessment (117 'at risk', 31'existing' COPD) from 748 people invited. Physiotherapists performed 145 pre/post bronchodilator spirometry assessments. Obstruction on post-bronchodilator spirometry was confirmed in 17% (19/114) of 'at risk' and 77% (24/31) of 'existing' COPD. Majority of cases were classified as GOLD Stage II (63%, n = 27). Quality of pre/post bronchodilator spirometries for FEV1 were classified as A (68%), B (19%) and C (5%).
Conclusion:
Physiotherapists integrated into primary care performed high quality spirometry testing, successfully case finding 'at risk' patients and identifying potential misdiagnosis of obstruction in some 'existing' COPD cases.
Trial Registration:
ANZCTR, ACTRN12619001127190. Registered 12 August 2019 - Retrospectively registered, http://www.ANZCTR.org.au/ACTRN12619001127190.aspx.
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