Spirometry in Primary Care in Navarre, Spain

Abstract

To analyze the use and quality of spirometry in primary care settings in Navarre, Spain. A questionnaire was completed simultaneously by professionals responsible for spirometry in all of the primary health care centers in Navarre. Data were collected on availability, model of spirometer, frequency of use, calibration, methods, personnel responsible for testing, and training of personnel. Then, baseline spirometry without a bronchodilator test was performed in 171 patients in their primary health care center and then the test was repeated on the same day in a hospital pneumology department. Spirometry was supervised by 2 pneumologists who jointly assessed the acceptability of the flow-volume curves. The quality of spirometry was assessed according to the recommendations of the American Thoracic Society and the interpretation of spirometry results according to the criteria of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR). A total of 90.9% of primary health care centers in Navarre have a spirometer, although 22% of those spirometers have never been used. Only 2 centers performed between 10 and 20 spirometry tests per week and none performed more than 20. In 96% of primary health care centers the spirometers were not regularly calibrated. The professionals who performed spirometry were not dedicated for that task in 51.2% of cases, and the mean period of supervised training was 10 hours. When comparisons were made between the mean values obtained in the primary care centers and the pneumology department, statistically significant differences were detected for forced vital capacity (P < .0001) and forced expiratory volume in the first second (P = .0002). Significant differences were also found between the flow-volume curves performed in the 2 different care settings for the initial and end portions of the curve as well as for the slope. The criteria for reproducibility recommended by the American Thoracic Society were not met in 76% of cases for forced vital capacity and 39.7% of cases for forced expiratory volume in the first second. Incorrect functional diagnosis occurred in 39.7% of spirometry tests and there was a tendency in the primary care settings to falsely diagnose patterns as restrictive and to inadequately classify the severity of obstruction. Despite the fact that spirometers are available in the majority of primary health care centers in Navarre, we found a marked underuse of these devices and little compliance with recommendations for the use of spirometry. Furthermore, the quality of the measurements performed in this care setting was very low.