Abstract
BackgroundAsthma 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.MethodsWe 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.ResultsSeven 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.ConclusionsA 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 materialThe online version of this article (doi:10.1186/s12890-016-0220-6) contains supplementary material, which is available to authorized users.
Highlights
Asthma is among the most common chronic diseases in adults
International guidelines have emphasized the importance of spirometry for both asthma diagnosis and control evaluation at regular intervals [3,4,5,6]
We conceived of an intervention which linked peer experts [physicians with asthma expertise and certified respiratory educators (CREs) with spirometry expertise] with their primary care counterparts, in a mentorship model
Summary
International guidelines have emphasized the importance of regular spirometry for asthma control evaluation. International guidelines have emphasized the importance of spirometry for both asthma diagnosis and control evaluation at regular intervals [3,4,5,6]. An administrative database analysis of 485 866 newly diagnosed asthmatics confirmed that only 42.6 % had spirometry around the time of diagnosis [13]. Reported reasons for this underuse among primary care physicians include limited access to spirometry, lack of spirometry interpretation skills, and concerns about the quality of in-office spirometry [15, 16]. Prior reports have identified poor coaching, poor effort, an inaccurate spirometer, and/or inappropriate interpretation as factors contributing to erroneous results and potentially harmful patient misclassifications [17, 18]
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