Abstract
BackgroundSpirometry testing is essential to confirm an obstructive lung disease, but studies have reported that a large proportion of patients diagnosed with COPD or asthma have no history of spirometry testing. Also, it has been shown that many patients are prescribed medication for obstructive lung disease without a relevant diagnosis or spirometry test registered. General practice characteristics have been reported to influence diagnosis and management of several chronic diseases. However, these findings are inconsistent, and it is uncertain whether practice characteristics influence spirometry testing among patients receiving medication for obstructive lung disease. The aim of this study was therefore to examine if practice characteristics are associated with spirometry testing among patients receiving first-time prescriptions for medication targeting obstructive lung disease.MethodsA national register-based cohort study was performed. All patients over 18 years receiving first-time prescriptions for medication targeting obstructive lung disease in 2008 were identified and detailed patient-specific data on sociodemographic status and spirometry tests were extracted. Information on practice characteristics like number of doctors, number of patients per doctor, training practice status, as well as age and gender of the general practitioners was linked to each medication user.ResultsPartnership practices had a higher odds ratio (OR) of performing spirometry compared with single-handed practices (OR 1.24, CI 1.09-1.40). We found a significant association between increasing general practitioner age and decreasing spirometry testing. This tendency was most pronounced among partnership practices, where doctors over 65 years had the lowest odds of spirometry testing (OR 0.25, CI 0.10-0.61). Training practice status was significantly associated with spirometry testing among single-handed practices (OR 1.40, CI 1.10-1.79).ConclusionSome of the variation in spirometry testing among patients receiving first-time prescriptions for medication targeting obstructive lung disease was associated with practice characteristics. This variation in performance may indicate a potential for quality improvement.
Highlights
Spirometry testing is essential to confirm an obstructive lung disease, but studies have reported that a large proportion of patients diagnosed with chronic obstructive pulmonary disease (COPD) or asthma have no history of spirometry testing
Spirometry testing is essential to confirm a diagnosis of obstructive lung disease, it enables the general practitioner (GP) to rule out airway obstruction in patients with respiratory symptoms caused by other illnesses, such as heart failure or lung cancer
When comparing all general practices, partnership practices had a higher odds ratio (OR) of performing spirometry compared with single-handed practices, Table 2
Summary
Spirometry testing is essential to confirm an obstructive lung disease, but studies have reported that a large proportion of patients diagnosed with COPD or asthma have no history of spirometry testing. General practice characteristics have been reported to influence diagnosis and management of several chronic diseases These findings are inconsistent, and it is uncertain whether practice characteristics influence spirometry testing among patients receiving medication for obstructive lung disease. We confirmed that a large proportion of patients prescribed medication targeting obstructive lung diseases do not undergo spirometry testing [4]. These patients may be medicated without having airway obstruction and exposed to unnecessary economic costs and medication risks [5,6]. Rural differences in spirometry testing have been reported [18]
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