Abstract
The present study assessed the impact of computerised spirometry interpretation expert support on the diagnostic achievements of general practitioners (GPs), and on GPs' decision making in diagnosing chronic respiratory disease. A cluster-randomised controlled trial was performed in 78 GPs who each completed 10 standardised paper case descriptions. Intervention consisted of support for GPs' spirometry interpretation either by an expert system (expert support group) or by sham information (control group). Agreement of GPs' diagnoses was compared with an expert panel judgement, which served as the primary outcome. Secondary outcomes were: additional diagnostic test rates; width of differential diagnosis; certainty of diagnosis; estimated severity of disease; referral rate; and medication or nonmedication changes. Effects were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). There were no differences between the expert support and control groups in the agreement between GPs and expert panel diagnosis of chronic obstructive pulmonary disease (OR (95% CI) 1.08 (0.70-1.66)), asthma (1.13 (0.70-1.80)), and absence of respiratory disease (1.32 (0.61-2.86)). A higher rate of additional diagnostic tests was observed in the expert support group (2.5 (1.17-5.35)). Computerised spirometry expert support had no detectable benefit on general practitioners' diagnostic achievements and the decision-making process when diagnosing chronic respiratory disease.
Highlights
A cluster-randomised controlled trial was performed in 78 general practitioners (GPs) who each completed 10 standardised paper case descriptions
All major chronic obstructive pulmonary disease (COPD) guidelines stress the central role of spirometry in diagnosing and managing chronic respiratory disease [1, 2], this does not guarantee that general practitioners (GPs) will use spirometry in the care of their patients with respiratory symptoms [3, 4]
Baseline characteristics of GPs Between January and October 2006, 78 GPs were enrolled in the present study; 36 were allocated to the expert support group and 42 to the control group
Summary
A cluster-randomised controlled trial was performed in 78 GPs who each completed 10 standardised paper case descriptions. Computerised spirometry expert support had no detectable benefit on general practitioners’ diagnostic achievements and the decision-making process when diagnosing chronic respiratory disease. Most common barriers that impede utilisation of spirometry in general practice are: the absence of properly trained staff [5]; the lack of time and practice support to fit spirometry into the daily practice routine [6]; the absence of a spirometer in the practice [7]; and GPs’ lack of confidence in the ability to interpret the test results [8, 9]. A recent survey [4] showed that one third of Australian GPs interpreted less than one spirometry test per week. Other recent nonrandomised studies [11, 12] confirm that spirometry increases diagnostic rates of chronic respiratory disease and may lead to management changes in a general practice population. In a previous study with patients with COPD, SCHERMER et al [13] observed that the most relevant indices, as measured by trained general practice staff, were comparable with those measured in pulmonary function laboratories
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