[Spirometry in family practice: still much to do... A point of view from family doctors]

[Pack-years threshold and HAS self-questionnaire for COPD early diagnosis]

INTRODUCTION

The Haute Autorité de santé (HAS) in France offers a patient self-questionnaire to optimize targeted chronic obstructive pulmonary disease (COPD) screening among at-risk patients in primary care. It includes smoking but does not have a threshold for pack-years (PY) smoked. The objective of this study was to compare the positive predictive values (PPV) of the HAS self-questionnaire alone and with the addition of a PY threshold.

METHODS

This was a prospective pilot study conducted in a multi-professional health centre. Identification among smoking or former smoking patients without a COPD diagnosis of subjects with a positive HAS self-questionnaire, a positive PY threshold, or both. We performed spirometry after bronchodilatation.

RESULTS

Thirty-five people were included in the study. All 35 had a positive PY threshold. The HAS questionnaire was positive for 22 of them (62.9%). Spirometry diagnosed 18 participants with COPD (51%). The PPV for the HAS questionnaire was 0.41 and the PPV for the HAS+PY questionnaire was 0.51. There was no statistically significant difference between these two PPVs (P=0.3692).

CONCLUSIONS

The addition of a PY threshold to the HAS self-questionnaire may allow better targeting of the population at risk of developing COPD.

Family medicine physician teachers and residents' intentions to prescribe and interpret spirometry: a descriptive cross-sectional study

Background: Spirometry is the best test to demonstrate airway obstruction, but remains underused in primary care. Objectives: We assessed, among family medicine physician teachers and residents, their intention to prescribe spirometry in patients suspected of chronic obstructive pulmonary disease and their intention to interpret the results. This evaluation is based on the theoretical framework proposed by Godin et al. for the study of factors influencing healthcare professionals' behavior. Methods: Participants of this descriptive cross-sectional study were recruited from eight Family medicine units (FMUs) of Laval University's network. They completed a 23-item self-administered questionnaire measuring their intention to prescribe and to interpret spirometry as well as some determinants of this intention (beliefs about capabilities, beliefs about consequences, social influence and moral norm). Answers to each of the items were scored on a Likert scale (score 1 to 7) where a higher score indicated a greater agreement with the statement. Results: Of the 284 eligible physicians, 104 were included. The mean score ± standard deviation of physicians' intention to prescribe spirometry (6.6 ± 0.7) was higher than to interpret the results (5.8 ± 1.5). Mean scores for all determinants of intention measured were also higher for prescription than for interpretation of spirometry. Conclusion: The results suggest that participants have a very strong intention to prescribe spirometry. Although the intention to interpret the results is positive, it is weaker than for the prescription of the test. Further studies will be needed to assess the barriers to spirometry interpretation.

[Study of the feasibility of spirometry in general practice]

COPD is common but is under-diagnosed by general practitioners (GP). GP have a major role in the early diagnosis of this disease. GP could have access to spirometry. The aim of this study was to evaluate the quality and interpretation of spirometry performed by primary care residents following a short education session. Three residents were trained in spirometry for half a day. They then performed spirometry on all smokers over the age of 35 visiting five general practices. The results were reviewed blindly by an independent specialist pulmonologist to assess their quality and interpretation. Among 184 eligible patients, 89% agreed to participate and 66% (n=107) came for the second appointment. The pulmonologist evaluated the quality of spirometry as good in 72% of cases, of suboptimal but acceptable quality in 20% and of poor quality in 8%. Interpretation was accurate in 91% of tests. The Kappa concordance coefficient between GPs and the expert was 0.93. Airflow obstruction was detected in 17.5% of the screened subjects. The average time for a consultation with spirometry was 19minutes. The consultation dedicated to spirometry was well accepted by patients. A short training has to be structured to allow GPs to perform and interpret spirometry properly. This work needs to be extended to better assess reproducibility in cases of abnormal spirometry.