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Alavi Foumani A, Alavi Foumani SA, Attarchi M, Etemadi Deilami A, Majlesi B, Ildari S, Eslami-Kenarsari H. Quality of spirometry tests in the field of occupational health. BMC Res Notes 2024; 17:11. [PMID: 38167347 PMCID: PMC10763193 DOI: 10.1186/s13104-023-06671-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/12/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The spirometry test is a valuable test to evaluate the performance of the respiratory system. The interpretation of the results is highly dependent on the quality of its performance, while the inappropriate quality results in unwanted consequences for individuals and the healthcare system. This study investigated the quality of spirometry tests performed in occupational health. METHODS In this cross-sectional study, the quality of 776 spirometry tests in different occupational centers by the specialists in Rasht, Iran, in 2020, based on the guidelines of the American Thoracic Society (ATS), was investigated. The quality and success rate of the test and the demographical characteristics of the operators and the participants were collected. All data was analyzed using SPSS software version 20. RESULTS Out of 776 spirometry tests, about 69.7% were unacceptable. Among the unacceptable tests, a pause error between inhalation and exhalation was identified in 7.4% of tests. Additionally, 4.6% of the unacceptable tests exhibited a cough error within the first second, while an exhalation error of less than six was observed in 85%. Repeatability errors were found in 60.9% of the tests. Furthermore, among some errors, the communication error between the characteristics of the technicians and the test performance errors were evident. CONCLUSION According to the results, most of the performed tests were unacceptable with no repeatability, which indicated that the validity and quality of spirometry tests and their interpretation were inappropriate in the field of occupational health in Rasht, Iran.
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Affiliation(s)
- Amirala Alavi Foumani
- Inflammatory Lung Diseases Research Center, Department of Internal Medicine, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Sardar Jangal Ave, Rasht, Iran
| | - Seyyed Ali Alavi Foumani
- Inflammatory Lung Diseases Research Center, Department of Internal Medicine, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Sardar Jangal Ave, Rasht, Iran.
| | - Mirsaeed Attarchi
- Department of Forensic Medicine, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Behzad Majlesi
- Rasht Health Center, Guilan university of medical sciences, Rasht, Iran
| | - Shima Ildari
- Inflammatory Lung Diseases Research Center, Department of Internal Medicine, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Sardar Jangal Ave, Rasht, Iran
| | - Habib Eslami-Kenarsari
- Inflammatory Lung Diseases Research Center, Department of Internal Medicine, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Sardar Jangal Ave, Rasht, Iran
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Oppenheimer J, Hanania NA, Chaudhuri R, Sagara H, Bailes Z, Fowler A, Peachey G, Pizzichini E, Slade D. Clinic vs Home Spirometry for Monitoring Lung Function in Patients With Asthma. Chest 2023; 164:1087-1096. [PMID: 37385337 DOI: 10.1016/j.chest.2023.06.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/05/2023] [Accepted: 06/21/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Studies examining agreement between home and clinic spirometry in patients with asthma are limited, with conflicting results. Understanding the strengths and limitations of telehealth and home spirometry is particularly important considering the SARS-CoV-2 pandemic. RESEARCH QUESTION How well do home and clinic measurements of trough FEV1 agree in patients with uncontrolled asthma? STUDY DESIGN AND METHODS This post hoc analysis used trough FEV1 data from the randomized double-anonymized parallel-group phase 3A CAPTAIN (205715; NCT02924688) and phase 2B 205832 (NCT03012061) trials in patients with uncontrolled asthma. CAPTAIN evaluated the impact of adding umeclidinium to fluticasone furoate/vilanterol via a single inhaler; the 205832 trial investigated adding umeclidinium to fluticasone furoate vs placebo. Trough FEV1 measurements were collected via home spirometry and supervised in-person spirometry in the research clinic. To compare home and clinic spirometry, we examined the time-course analyses of home and clinic trough FEV1, and generated post hoc Bland-Altman plots to assess agreement between home and clinic spirometry. RESULTS Data from 2,436 patients (CAPTAIN trial) and 421 patients (205832 trial) were analyzed. Treatment-related improvements in FEV1 were observed in both trials, using home and clinic spirometry. Improvements measured by home spirometry were of lower magnitude and less consistent than clinic measurements. Bland-Altman plots suggested poor agreement between home and clinic trough FEV1 at baseline and week 24. INTERPRETATION This post hoc comparison of home and clinic spirometry is the largest conducted in asthma. Results showed that home spirometry was less consistent than and lacked agreement with clinic spirometry, suggesting that unsupervised home readings are not interchangeable with clinic measurements. However, these findings may only be applicable to home spirometry using the specific device and coaching methods employed in these studies. Postpandemic, further research to optimize home spirometry use is needed. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; Nos.: NCT03012061 and NCT02924688; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
| | | | - Rekha Chaudhuri
- University of Glasgow, Glasgow, Scotland; Gartnavel General Hospital, Glasgow, Scotland
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3
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Sibbald SL, Misra V, daSilva M, Licskai C. A framework to support the progressive implementation of integrated team-based care for the management of COPD: a collective case study. BMC Health Serv Res 2022; 22:420. [PMID: 35354444 PMCID: PMC8966237 DOI: 10.1186/s12913-022-07785-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/14/2022] [Indexed: 12/22/2022] Open
Abstract
Background In Canada, there is widespread agreement about the need for integrated models of team-based care. However, there is less agreement on how to support the scale-up and spread of successful models, and there is limited empirical evidence to support this process in chronic disease management. We studied the supporting and mitigating factors required to successfully implement and scale-up an integrated model of team-based care in primary care. Methods We conducted a collective case study using multiple methods of data collection including interviews, document analysis, living documents, and a focus group. Our study explored a team-based model of care for chronic obstructive pulmonary disease (COPD) known as Best Care COPD (BCC) that has been implemented in primary care settings across Southwestern Ontario. BCC is a quality improvement initiative that was developed to enhance the quality of care for patients with COPD. Participants included healthcare providers involved in the delivery of the BCC program. Results We identified several mechanisms influencing the scale-up and spread of BCC and categorized them as Foundational (e.g., evidence-based program, readiness to implement, peer-led implementation team), Transformative (adaptive process, empowerment and collaboration, embedded evaluation), and Enabling Mechanisms (provider training, administrative support, role clarity, patient outcomes). Based on these results, we developed a framework to inform the progressive implementation of integrated, team-based care for chronic disease management. Our framework builds off our empirical work and is framed by local contextual factors. Conclusions This study explores the implementation and spread of integrated team-based care in a primary care setting. Despite the study’s focus on COPD, we believe the findings can be applied in other chronic disease contexts. We provide a framework to support the progressive implementation of integrated team-based care for chronic disease management.
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Affiliation(s)
- Shannon L Sibbald
- Faculty of Health Sciences, University of Western Ontario, 1151 Richmond St, HSB-334, London, ON, N6A 2K5, Canada. .,Department of Family Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, 1151 Richmond St, HSB-334, London, ON, N6A 2K5, Canada.
| | - Vaidehi Misra
- Faculty of Health Sciences, University of Western Ontario, 1151 Richmond St, HSB-334, London, ON, N6A 2K5, Canada
| | - Madelyn daSilva
- Faculty of Health Sciences, University of Western Ontario, 1151 Richmond St, HSB-334, London, ON, N6A 2K5, Canada
| | - Christopher Licskai
- Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
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4
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Kouri A, Dandurand RJ, Usmani OS, Chow CW. Exploring the 175-year history of spirometry and the vital lessons it can teach us today. Eur Respir Rev 2021; 30:30/162/210081. [PMID: 34615699 DOI: 10.1183/16000617.0081-2021] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 07/02/2021] [Indexed: 12/25/2022] Open
Abstract
175 years have elapsed since John Hutchinson introduced the world to his version of an apparatus that had been in development for nearly two centuries, the spirometer. Though he was not the first to build a device that sought to measure breathing and quantify the impact of disease and occupation on lung function, Hutchison coined the terms spirometer and vital capacity that are still in use today, securing his place in medical history. As Hutchinson envisioned, spirometry would become crucial to our growing knowledge of respiratory pathophysiology, from Tiffeneau and Pinelli's work on forced expiratory volumes, to Fry and Hyatt's description of the flow-volume curve. In the 20th century, standardization of spirometry further broadened its reach and prognostic potential. Today, spirometry is recognized as essential to respiratory disease diagnosis, management and research. However, controversy exists in some of its applications, uptake in primary care remains sub-optimal and there are concerns related to the way in which race is factored into interpretation. Moving forward, these failings must be addressed, and innovations like Internet-enabled portable spirometers may present novel opportunities. We must also consider the physiologic and practical limitations inherent to spirometry and further investigate complementary technologies such as respiratory oscillometry and other emerging technologies that assess lung function. Through an exploration of the storied history of spirometry, we can better contextualize its current landscape and appreciate the trends that have repeatedly arisen over time. This may help to improve our current use of spirometry and may allow us to anticipate the obstacles confronting emerging pulmonary function technologies.
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Affiliation(s)
- Andrew Kouri
- Division of Respirology, Dept of Medicine, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada
| | - Ronald J Dandurand
- Lakeshore General Hospital, Quebec, Canada.,Dept of Medicine, Respiratory Division, McGill University, Montreal, Quebec, Canada.,Montreal Chest Institute, Meakins-Christie Labs and Oscillometry Unit of the Centre for Innovative Medicine, McGill University Health Centre and Research Institute, Montreal, Canada
| | - Omar S Usmani
- National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, UK
| | - Chung-Wai Chow
- Dept of Medicine, University of Toronto, Toronto, Canada.,Division of Respirology and Multi-Organ Transplant Programme, Dept of Medicine, Toronto General Hospital, University Health Network, Toronto, Canada
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5
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Valentino AS, Eddy E, Woods Z, Wilken L. Pharmacist Provided Spirometry Services: A Scoping Review. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2021; 10:93-111. [PMID: 34485107 PMCID: PMC8409516 DOI: 10.2147/iprp.s248705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/30/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose Despite international guidelines' recommendations, spirometry is underutilized in the diagnosis and management of asthma and COPD. Spirometry may be an opportunity for trained pharmacists to meet the needs of patients with suspected or diagnosed lung conditions. The aim of this scoping review is to describe the literature including pharmacist provided spirometry services, specifically to identify: 1) the models of pharmacist provided spirometry services, and additional services commonly offered alongside spirometry, 2) pharmacist training and capability to obtain quality results, and (3) pharmacist, physician, and patient perspectives. Methods In September 2020, a comprehensive literature search in PubMed and EMBASE was conducted to identify all relevant literature on the topic of pharmacist provided spirometry services using the search term: "pharmacist or pharmacy" and "spirometry or pulmonary function test or lung function test." Literature was screened using inclusion/exclusion criteria and selected articles were charted and analyzed using the themes above. Results A total of 27 records were included. The scoping review found that pharmacist provided spirometry has been conducted around the world in community pharmacies and clinic settings. Community pharmacists may increase access to spirometry screening; the lack of communication with primary care providers and remuneration are barriers that need to be overcome to optimize the utility of the service. Clinic-based services are interprofessional and collaborative, allowing a patient to receive the test, results, diagnosis, and medication changes in one visit. Following comprehensive training, pharmacists felt confident in their ability to perform spirometry and met quality standards at acceptable rates. Conclusion Spirometry is an opportunity for pharmacists to improve evidence-based practice for screening and diagnosing lung conditions along with providing comprehensive services to complement testing. Data around provider and patient perspectives is limited and should be further investigated to determine if providers and patients would value and collaborate with pharmacists providing spirometry services.
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Affiliation(s)
- Alexa Sevin Valentino
- Pharmacy Practice and Science, The Ohio State University College of Pharmacy, Columbus, OH, USA
| | - Emily Eddy
- Pharmacy Practice, Ohio Northern University, Ada, OH, USA
| | - Zachary Woods
- Pharmacy Education and Innovation, The Ohio State University College of Pharmacy, Columbus, OH, USA
| | - Lori Wilken
- Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
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Fletcher MJ, Tsiligianni I, Kocks JWH, Cave A, Chunhua C, Sousa JCD, Román-Rodríguez M, Thomas M, Kardos P, Stonham C, Khoo EM, Leather D, van der Molen T. Improving primary care management of asthma: do we know what really works? NPJ Prim Care Respir Med 2020; 30:29. [PMID: 32555169 PMCID: PMC7300034 DOI: 10.1038/s41533-020-0184-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/13/2020] [Indexed: 12/14/2022] Open
Abstract
Asthma imposes a substantial burden on individuals and societies. Patients with asthma need high-quality primary care management; however, evidence suggests the quality of this care can be highly variable. Here we identify and report factors contributing to high-quality management. Twelve primary care global asthma experts, representing nine countries, identified key factors. A literature review (past 10 years) was performed to validate or refute the expert viewpoint. Key driving factors identified were: policy, clinical guidelines, rewards for performance, practice organisation and workforce. Further analysis established the relevant factor components. Review evidence supported the validity of each driver; however, impact on patient outcomes was uncertain. Single interventions (e.g. healthcare practitioner education) showed little effect; interventions driven by national policy (e.g. incentive schemes and teamworking) were more effective. The panel's opinion, supported by literature review, concluded that multiple primary care interventions offer greater benefit than any single intervention in asthma management.
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Affiliation(s)
- Monica J Fletcher
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK.
| | - Ioanna Tsiligianni
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Janwillem W H Kocks
- General Practitioners Research Institute, 59713 GH, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, The Netherlands
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Andrew Cave
- Department of Family Medicine, 6-10 University Terrace, University of Alberta, Edmonton, AB, T6G 2T4, Canada
| | - Chi Chunhua
- Peking University First Hospital, Beijing, China
| | - Jaime Correia de Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- 33ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Miguel Román-Rodríguez
- Primary Care Respiratory Research Unit, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Spain
| | - Mike Thomas
- Department of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, SO16 5ST, UK
| | - Peter Kardos
- Respiratory, Allergy and Sleep Unit at Red Cross Maingau Hospital, Friedberger Anlage 31-32, 60316, Frankfurt, Germany
| | - Carol Stonham
- NHS Gloucestershire Clinical Commissioning Group, Brockworth, UK
| | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - David Leather
- Global Respiratory Franchise, GlaxoSmithKline plc., GSK House, 980 Great West Rd, Brentford, Middlesex, TW8 9GS, UK
| | - Thys van der Molen
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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7
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Graham BL, Steenbruggen I, Miller MR, Barjaktarevic IZ, Cooper BG, Hall GL, Hallstrand TS, Kaminsky DA, McCarthy K, McCormack MC, Oropez CE, Rosenfeld M, Stanojevic S, Swanney MP, Thompson BR. Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement. Am J Respir Crit Care Med 2020; 200:e70-e88. [PMID: 31613151 PMCID: PMC6794117 DOI: 10.1164/rccm.201908-1590st] [Citation(s) in RCA: 1862] [Impact Index Per Article: 465.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: Spirometry is the most common pulmonary function test. It is widely used in the assessment of lung function to provide objective information used in the diagnosis of lung diseases and monitoring lung health. In 2005, the American Thoracic Society and the European Respiratory Society jointly adopted technical standards for conducting spirometry. Improvements in instrumentation and computational capabilities, together with new research studies and enhanced quality assurance approaches, have led to the need to update the 2005 technical standards for spirometry to take full advantage of current technical capabilities.Methods: This spirometry technical standards document was developed by an international joint task force, appointed by the American Thoracic Society and the European Respiratory Society, with expertise in conducting and analyzing pulmonary function tests, laboratory quality assurance, and developing international standards. A comprehensive review of published evidence was performed. A patient survey was developed to capture patients' experiences.Results: Revisions to the 2005 technical standards for spirometry were made, including the addition of factors that were not previously considered. Evidence to support the revisions was cited when applicable. The experience and expertise of task force members were used to develop recommended best practices.Conclusions: Standards and consensus recommendations are presented for manufacturers, clinicians, operators, and researchers with the aims of increasing the accuracy, precision, and quality of spirometric measurements and improving the patient experience. A comprehensive guide to aid in the implementation of these standards was developed as an online supplement.
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Kupczyk M, Hofman A, Kołtowski Ł, Kuna P, Łukaszyk M, Buczyłko K, Bodzenta-Łukaszyk A, Nastałek P, Soliński M, Dąbrowiecki P. Home self-monitoring in patients with asthma using a mobile spirometry system. J Asthma 2020; 58:505-511. [PMID: 31877056 DOI: 10.1080/02770903.2019.1709864] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Self-management is an appealing strategy for prevention of asthma exacerbations. This study aimed to evaluate the feasibility and safety of a portable spirometer for unsupervised home spirometry measurements among patients with asthma. METHODS A multi-center, prospective, single-arm, open study recruited 86 patients with controlled or partly controlled asthma (41 women, 38.6 ± 10.4 y/o and 45 men, 36.2 ± 12.1 y/o). After a training session, patients performed daily spirometry at home with the AioCare® mobile spirometry system. Each spirometry examination was recorded and evaluated according to the ATS/ERS acceptability and repeatability criteria. The primary endpoint was defined as three or more acceptable examinations in any given seven-day period (+/- 1 day) during any of the three weeks of the study. The system allowed for online review of measurements by physicians/nurses to provide feedback to patients. RESULTS Of 78 patients with complete data, 67 (86%) achieved the primary endpoint. Seventy-five (96%) participants used the device correctly once or more, and 10 (13%) patients succeeded every single day over the three-week follow-up. The rate of acceptable spirometry examinations differed between the sites (p = 0.013). Retraining was required in 20 of 62 (32%) eligible patients, and successful in 8 individuals (40%). Satisfaction with the AioCare® system was high, 90% of respondents perceived it as useful and user-friendly. CONCLUSIONS Self-monitoring of asthma with a connected mobile spirometer is feasible, safe and satisfactory for patients with asthma. It remains to be established whether unsupervised home spirometry measurements may improve early diagnosis and outcomes of self-management in cases of exacerbation or loss of asthma control.
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Affiliation(s)
- Maciej Kupczyk
- Department of Internal Medicine, Asthma, and Allergy, Medical University of Lodz, Lodz, Poland
| | | | - Łukasz Kołtowski
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Kuna
- Department of Internal Medicine, Asthma, and Allergy, Medical University of Lodz, Lodz, Poland
| | - Mateusz Łukaszyk
- Department of Allergology and Internal Medicine, University Hospital of Bialystok, Bialystok, Poland
| | | | - Anna Bodzenta-Łukaszyk
- Department of Allergology and Internal Medicine, University Hospital of Bialystok, Bialystok, Poland.,University of Economics and Innovation, Lublin, Poland
| | - Paweł Nastałek
- Department of Pulmonology, Second Department of Internal Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Mateusz Soliński
- Faculty of Physics, Warsaw University of Technology, Warsaw, Poland
| | - Piotr Dąbrowiecki
- Department of Infectious Diseases and Allergology, Military Institute of Medicine, Warsaw, Poland
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Ferrone M, Masciantonio MG, Malus N, Stitt L, O'Callahan T, Roberts Z, Johnson L, Samson J, Durocher L, Ferrari M, Reilly M, Griffiths K, Licskai CJ. The impact of integrated disease management in high-risk COPD patients in primary care. NPJ Prim Care Respir Med 2019; 29:8. [PMID: 30923313 PMCID: PMC6438975 DOI: 10.1038/s41533-019-0119-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 02/26/2019] [Indexed: 12/23/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) have a reduced quality of life (QoL) and exacerbations that drive health service utilization (HSU). A majority of patients with COPD are managed in primary care. Our objective was to evaluate an integrated disease management, self-management, and structured follow-up intervention (IDM) for high-risk patients with COPD in primary care. This was a one-year multi-center randomized controlled trial. High-risk, exacerbation-prone COPD patients were randomized to IDM provided by a certified respiratory educator and physician, or usual physician care. IDM received case management, self-management education, and skills training. The primary outcome, COPD-related QoL, was measured using the COPD Assessment Test (CAT). Of 180 patients randomized from 8 sites, 81.1% completed the study. Patients were 53.6% women, mean age 68.2 years, post-bronchodilator FEV1 52.8% predicted, and 77.4% were Global Initiative for Obstructive Lung Disease Stage D. QoL-CAT scores improved in IDM patients, 22.6 to 14.8, and worsened in usual care, 19.3 to 22.0, adjusted difference 9.3 (p < 0.001). Secondary outcomes including the Clinical COPD Questionnaire, Bristol Knowledge Questionnaire, and FEV1 demonstrated differential improvements in favor of IDM of 1.29 (p < 0.001), 29.6% (p < 0.001), and 100 mL, respectively (p = 0.016). Compared to usual care, significantly fewer IDM patients had a severe exacerbation, -48.9% (p < 0.001), required an urgent primary care visit for COPD, -30.2% (p < 0.001), or had an emergency department visit, -23.6% (p = 0.001). We conclude that IDM self-management and structured follow-up substantially improved QoL, knowledge, FEV1, reduced severe exacerbations, and HSU, in a high-risk primary care COPD population. Clinicaltrials.gov NCT02343055.
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Affiliation(s)
- Madonna Ferrone
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada
- Hotel-Dieu Grace Healthcare, Windsor, ON, Canada
| | - Marcello G Masciantonio
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada
- Western University, London Health Sciences Centre, London, ON, Canada
| | - Natalie Malus
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada
- Western University, London Health Sciences Centre, London, ON, Canada
| | - Larry Stitt
- Lawson Health Research Institute, London, ON, Canada
| | | | - Zofe Roberts
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada
| | - Laura Johnson
- Chatham Kent Family Health Team, Chatham, ON, Canada
| | - Jim Samson
- Leamington Family Health Team, Leamington, ON, Canada
| | - Lisa Durocher
- Leamington Family Health Team, Leamington, ON, Canada
| | | | | | | | - Christopher J Licskai
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada.
- Western University, London Health Sciences Centre, London, ON, Canada.
- Lawson Health Research Institute, London, ON, Canada.
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10
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Murray S, Labbé S, Kaplan A, Petrasko K, Waserman S. A multi-stakeholder perspective on asthma care in Canada: findings from a mixed methods needs assessment in the treatment and management of asthma in adults. Allergy Asthma Clin Immunol 2018; 14:36. [PMID: 30214459 PMCID: PMC6130055 DOI: 10.1186/s13223-018-0261-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/30/2018] [Indexed: 01/29/2023] Open
Abstract
Background Although several aspects of asthma care have been identified as being sub-optimal in Canada, such as patient education, practice guideline adoption, and access to care, there remains a need to determine the extent to which these gaps remain, so as to investigate their underlying causes, and potential solutions. Methods An ethics-approved mixed methods educational needs assessment was conducted in four Canadian provinces (Alberta, British Columbia, Ontario, and Quebec), combining a qualitative phase (45-min semi-structured interviews with community-based healthcare providers and key stakeholders) and a quantitative phase (15-min survey, healthcare providers only). Results A total of 234 participants were included in the study, 44 in semi-structured interviews and 190 in the online survey. Five clinical areas were reported to be suboptimal by multiple categories of participants, and specific causes were identified for each. These areas included: Integration of guidelines into clinical practice, use of spirometry, individualisation of asthma devices to patient needs, emphasis on patient adherence and self-management, and clarity regarding roles and responsibilities of different members of the asthma healthcare team. Common causes for gaps in all these areas included suboptimal knowledge amongst healthcare providers, differing perceptions on the importance of certain interventions, and inadequate communication between healthcare providers. Conclusions This study provides a better understanding of the specific causes underlying common gaps and challenges in asthma care in Canada. This information can inform future continuing medical education, and help providers in community settings obtain access to adequate materials, resources, and training to support optimal care of adult patients with asthma.
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Affiliation(s)
- Suzanne Murray
- 1AXDEV Group Inc., 210-8, Place du Commerce, Brossard, QC J4W 3H2 Canada
| | - Sara Labbé
- 1AXDEV Group Inc., 210-8, Place du Commerce, Brossard, QC J4W 3H2 Canada
| | - Alan Kaplan
- 2Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON M5G 1V7 Canada
| | | | - Susan Waserman
- 4Division of Clinical Immunology and Allergy, McMaster University, 1280 Main St West, HSC 3V49, Hamilton, ON L8S 4K1 Canada
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Quality and learning aspects of the first 9000 spirometries of the LifeGene study. NPJ Prim Care Respir Med 2018; 28:6. [PMID: 29459619 PMCID: PMC5818518 DOI: 10.1038/s41533-018-0073-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 12/12/2017] [Accepted: 01/16/2018] [Indexed: 11/12/2022] Open
Abstract
Spirometry requires the patient to cooperate and do the manoeuvre 'right' for reliable results. Algorithms to assess test quality as well as educational recommendations for personnel are defined in guidelines. We compared the quality of forced spirometry tests performed by spirometry technicians with little or no previous experience of spirometry using spirometry systems with different modes of feedback. In both cases, the spirometry technician received general feedback on the screen based on ATS/ERS guidelines, such as 'exhale faster' and 'exhale longer'. The major difference was whether quality grading system of the complete session was available simultaneously on screen, or in the printed report afterwards. Two parts of the same population-based study (LifeGene), the pilot (LG1) and the first part (LG2) of the subsequent study, were compared retrospectively. In LG1 (on-screen grading) approved examination quality was achieved for 88% of the 10 first subjects for each spirometry technician compared to 70% in LG2 (printed grading afterwards). The corresponding values after 40 subjects was 94 % in LG1, compared to 73% in LG2, and after the first ten subjects there was no apparent quality improvement in either LG1 or LG2. The quality for LG1 is among the highest reported in the literature even though the spirometry technician were relatively inexperienced. We conclude that on-screen grading in addition to general technical quality feedback is powerful in enhancing the spirometry test session quality. On-screen, real-time feedback for technicians and patients during spirometry raises the efficiency and quality of tests. Spirometry measures air flow passing through the lungs to determine lung function. However, the test relies on patients co-operating and performing at their best to achieve high quality results and avoid mis-diagnosis. As part of the LifeGene study at Karolinska University in Stockholm, Sweden, Mikaela Qvarfordt and co-workers trialled an automated method of providing feedback during testing to inexperienced spirometry technicians and their patients. 9000 patients were split into two groups, LG1 and LG2. LG1 received on-screen feedback plus a quality grade during testing, while LG2 received grading feedback after tests had finished. For every technician, approved quality tests were achieved for 94 per cent of their first 40 patients in LG1, compared with 73 per cent in LG2.
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Cawley MJ, Warning WJ. Impact of a Pharmacist-driven Spirometry Clinic Service within a Community Family Health Center: A 5-year Retrospective Review. J Res Pharm Pract 2018; 7:88-94. [PMID: 30050962 PMCID: PMC6036877 DOI: 10.4103/jrpp.jrpp_17_101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: This study was designed to describe the impact of a trained pharmacist in performing quality spirometry testing within a community family health center. Methods: This was a retrospective, cohort study of 150 physician-referred patients who attended their scheduled spirometry office appointment between November 2008 and December 2013. Information obtained included type of the disease (patients with obstructive or restrictive pulmonary disease), calculated lung age decline due to smoking history, quality of spirometry testing, and percentage of patients requiring pulmonary drug regimen alterations due to spirometry results. Pearson correlation and descriptive statistics were used to address study objectives. Findings: Spirometry testing performed by a pharmacist resulted in 87% of tests meeting guidelines for quality. Testing identified patients with reversible airway disease (39%), chronic obstructive pulmonary disease (21%), restrictive (11%), and mixed obstructive/restrictive (11%) lung defect. Patients with abnormal spirometry demonstrated a greater smoking pack-year history and calculated lung age than patients with normal spirometry (29.1 pack-years vs. 17 pack-years; P = 0.024 and 76.3 years vs. 54.6 years; P < 0.001, respectively). A weak correlation was found between a 29.1 smoking pack-year history and forced vital capacity (r = −0.3593, P = 0.018). The pharmacist assisted in modifying pulmonary drug regimens in 69% of patients based on evidence-based guidelines. Conclusion: A pharmacist-driven spirometry service was associated with quality testing results, identified respiratory disease abnormalities, and helped modifications of pulmonary drug regimens based on evidence-based guidelines. Future direction of this service may include collaborative practice agreements with physicians to expand services of pharmacists to include spirometry testing.
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Affiliation(s)
- Michael J Cawley
- Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, PA, USA
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13
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Lian N, Li L, Ren W, Jiang Z, Zhu L. Angle β of greater than 80° at the start of spirometry may identify high-quality flow volume curves. Respirology 2016; 22:527-532. [PMID: 27899005 DOI: 10.1111/resp.12950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 08/04/2016] [Accepted: 08/27/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Ningfang Lian
- Department of Respiratory Medicine; The First Affiliated Hospital of Fujian Medical University; Fuzhou China
| | - Li Li
- Department of Respiratory Medicine; Zhongshan Hospital, Fudan University; Shanghai China
| | - Weiying Ren
- Department of Geriatrics; Zhongshan Hospital, Fudan University; Shanghai China
| | - Zhilong Jiang
- Department of Respiratory Medicine; Zhongshan Hospital, Fudan University; Shanghai China
| | - Lei Zhu
- Department of Respiratory Medicine; Zhongshan Hospital, Fudan University; Shanghai China
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Ohar JA, Yawn BP, Ruppel GL, Donohue JF. A retrospective study of two populations to test a simple rule for spirometry. BMC FAMILY PRACTICE 2016; 17:65. [PMID: 27259805 PMCID: PMC4893220 DOI: 10.1186/s12875-016-0467-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 05/23/2016] [Indexed: 11/10/2022]
Abstract
Background Chronic lung disease is common and often under-diagnosed. Methods To test a simple rule for conducting spirometry we reviewed spirograms from two populations, occupational medicine evaluations (OME) conducted by Saint Louis and Wake Forest Universities at 3 sites (n = 3260, mean age 64.14 years, 95 % CI 58.94–69.34, 97 % men) and conducted by Wake Forest University preop clinic (POC) at one site (n = 845, mean age 62.10 years, 95 % CI 50.46–73.74, 57 % men). This retrospective review of database information that the first author collected prospectively identified rates, types, sensitivity, specificity and positive and negative predictive value for lung function abnormalities and associated mortality rate found when conducting spirometry based on the 20/40 rule (≥20 years of smoking in those aged ≥ 40 years) in the OME population. To determine the reproducibility of the 20/40 rule for conducting spirometry, the rule was applied to the POC population. Results A lung function abnormality was found in 74 % of the OME population and 67 % of the POC population. Sensitivity of the rule was 85 % for an obstructive pattern and 77 % for any abnormality on spirometry. Positive and negative predictive values of the rule for a spirometric abnormality were 74 and 55 %, respectively. Patients with an obstructive pattern were at greater risk of coronary heart disease (odds ratio (OR) 1.39 [confidence interval (CI) 1.00–1.93] vs. normal) and death (hazard ratio (HR) 1.53, 95 % CI 1.20–1.84) than subjects with normal spirometry. Restricted spirometry patterns were also associated with greater risk of coronary disease (odds ratio (OR) 1.7 [CI 1.23–2.35]) and death (Hazard ratio 1.40, 95 % CI 1.08–1.72). Conclusions Smokers (≥ 20 pack years) age ≥ 40 years are at an increased risk for lung function abnormalities and those abnormalities are associated with greater presence of coronary heart disease and increased all-cause mortality. Use of the 20/40 rule could provide a simple method to enhance selection of candidates for spirometry evaluation in the primary care setting.
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Affiliation(s)
- Jill A Ohar
- Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1054, USA.
| | - Barbara P Yawn
- Department of Research, Olmsted Medical Center, Rochester, MN, 55904, USA
| | - Gregg L Ruppel
- Pulmonary, Critical Care & Sleep Medicine, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - James F Donohue
- University of North Carolina Chapel Hill, Chapel Hill, NC, USA
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Gupta S, Moosa D, MacPherson A, Allen C, Tamari IE. Effects of a 12-month multi-faceted mentoring intervention on knowledge, quality, and usage of spirometry in primary care: a before-and-after study. BMC Pulm Med 2016; 16:56. [PMID: 27103316 PMCID: PMC4839111 DOI: 10.1186/s12890-016-0220-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 04/13/2016] [Indexed: 11/10/2022] Open
Abstract
Background Asthma is among the most common chronic diseases in adults. International guidelines have emphasized the importance of regular spirometry for asthma control evaluation. However, spirometry use in primary care remains low across jurisdictions. We sought to design and evaluate a knowledge translation intervention to address both the poor quality of spirometry and the underuse of spirometry in primary care. Methods We designed a 1-year intervention consisting of initial interactive education and hands-on training followed by unstructured peer expert mentoring (through an online portal, email, telephone, videoconference, fax, and/or in-person). We recruited physician and allied health mentees from across primary care sites in Ontario, Canada. We compared spirometry-related knowledge immediately before and after the 1-year intervention period and the quality of spirometry testing and the usage of spirometry in patients with asthma in the year before and the year of the intervention. Results Seven of 10 (70 %) invited sites participated, including 25/90 (28 %) invited allied health mentees and 23/68 (34 %) invited physician mentees. We recruited 7 physician mentors and 4 allied health mentors to form 3 mentor-mentee pods. Spirometry knowledge scores increased from 21.4 +/− 3.1 pre- to 27.3 +/− 3.5 (out of 35) (p < 0.01) post-intervention. Spirometry acceptability and repeatability criteria were met by 59/191 (30.9 %) spirometries and 86/193 (44.6 %) spirometries [odds ratio 1.7 (1.0, 3.0)], in the pre-intervention and intervention periods, respectively. Spirometry was ordered in 75/512 (14.6 %) and 129/336 (38.4 %) respiratory visits (p < 0.01), and in 20/3490 (0.6 %) and 36/2649 (1.4 %) non-respiratory visits (p < 0.01), in the pre-intervention and intervention periods, respectively. Conclusions A mentorship-based intervention involving physicians and allied health team members can enhance knowledge, quality, and actual use of spirometry in real world primary care settings. A future controlled study should assess the impact of this intervention on patient outcomes, its cost-effectiveness, and its sustainability. Electronic supplementary material The online version of this article (doi:10.1186/s12890-016-0220-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Samir Gupta
- Department of Medicine, University of Toronto, Toronto, Canada. .,Division of Respirology, Department of Medicine, St. Michael's Hospital, Toronto, Canada. .,Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada. .,, Suite 6042, Bond Wing, 30 Bond St., M5B 1W8, Toronto, ON, Canada.
| | | | | | - Christopher Allen
- Department of Medicine and Firestone Institute for Respiratory Health, McMaster University, Hamilton, Canada
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Giraud V, Beauchet A, Gomis T, Chinet T. Feasibility of spirometry in primary care to screen for COPD: a pilot study. Int J Chron Obstruct Pulmon Dis 2016; 11:335-40. [PMID: 26929617 PMCID: PMC4760207 DOI: 10.2147/copd.s96385] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background COPD is a frequent but underdiagnosed disease whose diagnosis relies on the spirometric demonstration of bronchial obstruction. Spirometry use by general practitioners could represent the first line in COPD diagnosis. Objective Because duration of spirometry is retarding its development in primary care, we decided to measure the time it requires in the primary-care context in France. Methods Ten volunteer general practitioners were trained during two 3-hour theoretical and practical continuing education sessions. Then, from October 2013 to May 2014, they included patients without any known respiratory disease but at risk of developing COPD (age: ≥40 years, smoker: ≥20 pack-years). The duration of spirometry and its quality were evaluated according to the following acceptability criteria: 1) expiration ≥6 seconds or reaching a plateau; 2) good start with an early peak flow, curve peaked on top and not flat; 3) no artifacts; and 4) reproducibility criteria, ie, forced expiratory volume in 1 second and forced vital capacity differences between the two best spirometry curves ≤0.15 L. Quality of the spirograms was defined as optimal when all the criteria were met and acceptable when all the criteria were satisfied except the reproducibility criterion, otherwise, it was unacceptable. Results For the 152 patients included, the 142 assessable spirometries lasted for 15.2±5.9 minutes. Acceptability criteria 1–3, respectively, were satisfied for 90.1%, 89.4%, and 91.5% of patients and reproducibility criterion 4 for 56.3%. Quality was considered optimal for 58.5% of the curves and acceptable for 30.2%. Conclusion The duration of spirometry renders it poorly compatible with the current primary-care practice in France other than for dedicated consultations. Moreover, the quality of spirometry needs to be improved.
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Affiliation(s)
- Violaine Giraud
- AP-HP, Department of Pneumology and Thoracic Oncology, Ambroise-Paré Hospital, Paris, France; UEFR Paris île-de-France Ouest, Versailles Saint Quentin-en-Yvelines University, Paris, France
| | - Alain Beauchet
- Public Health Department, Unité de Recherche Clinique, Hôpitaux Universitaires Paris Ile-de-France Ouest, Paris, France
| | | | - Thierry Chinet
- AP-HP, Department of Pneumology and Thoracic Oncology, Ambroise-Paré Hospital, Paris, France; UEFR Paris île-de-France Ouest, Versailles Saint Quentin-en-Yvelines University, Paris, France
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Cawley MJ, Warning WJ. Pharmacists performing quality spirometry testing: an evidence based review. Int J Clin Pharm 2015; 37:726-33. [PMID: 26148860 DOI: 10.1007/s11096-015-0160-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 06/29/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The scope of pharmacist services for patients with pulmonary disease has primarily focused on drug related outcomes; however pharmacists have the ability to broaden the scope of clinical services by performing diagnostic testing including quality spirometry testing. Studies have demonstrated that pharmacists can perform quality spirometry testing based upon international guidelines. AIM OF THE REVIEW The primary aim of this review was to assess the published evidence of pharmacists performing quality spirometry testing based upon American Thoracic Society/European Respiratory Society (ATS/ERS) guidelines. In order to accomplish this, the description of evidence and type of outcome from these services were reviewed. METHODS A literature search was conducted using five databases [PubMed (1946-January 2015), International Pharmaceutical Abstracts (1970 to January 2015), Cumulative Index of Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews] with search terms including pharmacy, spirometry, pulmonary function, asthma or COPD was conducted. Searches were limited to publications in English and reported in humans. In addition, Uniform Resource Locators and Google Scholar searches were implemented to include any additional supplemental information. RESULTS Eight studies (six prospective multi-center trials, two retrospective single center studies) were included. Pharmacists in all studies received specialized training in performing spirometry testing. Of the eight studies meeting inclusion and exclusion criteria, 8 (100%) demonstrated acceptable repeatability of spirometry testing based upon standards set by the ATS/ERS guidelines. Acceptable repeatability of seven studies ranged from 70 to 99% consistent with published data. CONCLUSION Available evidence suggests that quality spirometry testing can be performed by pharmacists. More prospective studies are needed to add to the current evidence of quality spirometry testing performed by pharmacists and to measure health outcomes of the pulmonary patient.
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Affiliation(s)
- Michael J Cawley
- Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy, University of the Sciences, 600 South 43rd Street, Philadelphia, PA, 19104-4495, USA.
| | - William J Warning
- Family Medicine Residency Program, Crozer-Keystone Center for Family Health, Springfield, PA, USA
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18
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Hoy HM, O'Keefe LC. Practical guidance on the recognition of uncontrolled asthma and its management. J Am Assoc Nurse Pract 2015; 27:466-75. [PMID: 26119777 DOI: 10.1002/2327-6924.12284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 05/12/2015] [Indexed: 12/30/2022]
Abstract
PURPOSE To highlight the significance of asthma in primary care and offer a practitioner-friendly interpretation of the asthma guidelines for the busy provider, while introducing new treatment options currently in clinical trials, such as the once-daily long-acting anticholinergic bronchodilator tiotropium Respimat. DATA SOURCES Articles with relevant adult data published between 2004 and 2015 were identified via PubMed. Additional references were obtained by reviewing bibliographies from selected articles. CONCLUSIONS In the United States, uncontrolled or symptomatic asthma is common, with rates of 46%-78% in primary care. Uncontrolled asthma has a substantial impact on patients' quality of life and represents a significant healthcare burden. Nurse practitioners can improve patients' asthma control through education, monitoring, assessment, and treatment. Although asthma management guidelines are readily available, the authors recognize that nurse practitioners see patients with multiple comorbidities, all of which have treatment guidelines of their own. IMPLICATIONS FOR PRACTICE Nurse practitioners have a compelling opportunity as frontline caregivers and patient educators to recognize and assess uncontrolled asthma, along with determining the steps necessary to help patients gain and maintain symptom control.
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Affiliation(s)
- Haley M Hoy
- College of Nursing, University of Alabama in Huntsville, Huntsville, Alabama
| | - Louise C O'Keefe
- College of Nursing, University of Alabama in Huntsville, Huntsville, Alabama
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Cheung HJ, Cheung L. Coaching patients during pulmonary function testing: A practical guide. CANADIAN JOURNAL OF RESPIRATORY THERAPY : CJRT = REVUE CANADIENNE DE LA THERAPIE RESPIRATOIRE : RCTR 2015; 51:65-8. [PMID: 26283871 PMCID: PMC4530837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Pulmonary function tests are an important tool to assist in the diagnosis and management of patients with respiratory disease. Ensuring that the tests are of acceptable quality is vital. Acceptable pulmonary function test quality requires, among others, optimal patient performance. Optimal patient performance, in turn, requires adequate coaching from registered respiratory therapists (RRTs) and other pulmonary function laboratory personnel. The present article provides techniques and tips to help RRTs coach patients during testing. The authors briefly review the components of pulmonary function testing, then describe factors that may hinder a patient's performance, list common mistakes that patients make during testing, and provide tips that RRTs can use to help patients optimize their performance.
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Affiliation(s)
- Heidi J Cheung
- Pulmonary Function Laboratory, Kaye Edmonton Clinic, University of Alberta Hospital
| | - Lawrence Cheung
- Department of Medicine, University of Alberta, Edmonton, Alberta
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López-Campos JL, Soriano JB, Calle M. A comprehensive, national survey of spirometry in Spain: current bottlenecks and future directions in primary and secondary care. Chest 2014; 144:601-609. [PMID: 23411500 DOI: 10.1378/chest.12-2690] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND We aimed to evaluate the availability and practice of spirometry, training of technicians, and spirometer features and maintenance in Spain in both primary care (PC) and secondary care (SC) centers. METHODS We used a nationwide, cross-sectional, 36-item telephone survey of health-care centers in Spain to target the technician in charge of conducting spirometries in PC and SC centers where outpatient respiratory patients are routinely evaluated. The questions surveyed for resources, training, spirometer use, bronchodilator tests, and spirometer features and maintenance. RESULTS Of a total of 1,259 centers screened, 605 PC centers (21.2% of the PC centers in Spain) and 200 SC centers (24.9% of the SC centers in Spain) were surveyed. The response rate was 85.4% for PC centers and 75.1% for SC centers. All together, 19% of screened centers did not have a spirometer or were not using it. The number of spirometers per center and spirometries conducted per week was higher in SC centers than in PC centers (P < .001). Most centers received training for conducting spirometries, but this was periodically done in < 40%. Most centers used two inhalations of salbutamol for the bronchodilator test, but the international criteria of a positive test was considered only in 55.8% of PC and 52.8% of SC centers. Calibration of the spirometer was never done in 10.5% of PC and 3.1% of SC centers. CONCLUSIONS This survey maps for the first time, to our knowledge, the current situation of spirometry in Spain, identifying bottlenecks and suggesting future directions applicable in both PC and SC centers and elsewhere.
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Affiliation(s)
- Jose Luis López-Campos
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), Seville; Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid.
| | - Joan B Soriano
- Fundación Caubet-Cimera Islas Baleares, Bunyola, Mallorca, Illes Balears
| | - Myriam Calle
- Servicio de Neumología, Hospital Universitario San Carlos, Madrid, Spain
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Sanchez-Solis M. Could a Visual Analogue Scale be useful, in real life, to manage children with asthma? Allergol Immunopathol (Madr) 2013; 41:357-8. [PMID: 24295930 DOI: 10.1016/j.aller.2013.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 11/06/2013] [Indexed: 11/18/2022]
Affiliation(s)
- M Sanchez-Solis
- Pediatric Respiratory Unit, Virgen de la Arrixaca University Hospital, Pabellón Docente Universitario, El Palmar, Murcia, Spain.
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Abstract
Canadian Thoracic Society (CTS) clinical guidelines for asthma and chronic obstructive pulmonary disease (COPD) specify that spirometry should be used to diagnose these diseases. Given the burden of asthma and COPD, most people with these diseases will be diagnosed in the primary care setting. The present CTS position statement was developed to provide guidance on key factors affecting the quality of spirometry testing in the primary care setting. The present statement may also be used to inform and guide the accreditation process for spirometry in each province. Although many of the principles discussed are equally applicable to pulmonary function laboratories and interpretation of tests by respirologists, they are held to a higher standard and are outside the scope of the present statement.
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Enright P, Schermer T. Don't pay for poor quality spirometry tests. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2013; 22:15-6. [PMID: 23443224 PMCID: PMC6442761 DOI: 10.4104/pcrj.2013.00023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Paul Enright
- Professor of Medicine (retired), College of Public Health and Department of Medicine, The University of Arizona, Tucson, AZ, USA
- College of Public Health and Department of Medicine, The University of Arizona, Post office box 675, Mount Lemmon, Tucson, AZ, USA Tel: +520 576 1030 E-mail:
| | - Tjard Schermer
- Associate Professor and Director, COPD & Asthma Research & Development Unit, Department of Primary and Community Care, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands
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