Abstract
Interpreting spirometry results has proven challenging in primary care practice, among others potentially leading to under- and misdiagnosis of COPD. In telepulmonology a general practitioner (GP) digitally consults a pulmonologist to support the interpretation of spirometry results. This study assessed the effect of telepulmonology on quality and efficiency of care. Quality of care was measured by five indicators, among others the percentage of TelePulmonology Consultations (TPCs) sent by GPs for advice, percentage of those TPCs resulting in a physical referral, and educational effect of telepulmonology as experienced by GPs. Efficiency was defined as the percentage of prevented unnecessary physical referrals of patients to the pulmonologist. Between April 2009 and November 2012 1.958 TPCs were sent by 158 GPs to 32 pulmonologists. Sixty-nine percent of the TPCs were sent for advice. Based on the advice of thepulmonologist 18% of these TPCs led to a physical referral of patients who would not havebeen referred without telepulmonology. Thirty-one percent of the TPCs were intended to prevent a physical referral, 68% of these actually prevented a physical referral to a pulmonologist. The results show telepulmonology can contribute to quality of care by supporting GPs and can additionally prevent unnecessary physical referrals.
Highlights
Chronic Obstructive Pulmonary Disease (COPD) is a chronic lung disorder characterized by a not fully reversible airflow limitation that is usually progressive [1] and constitutes the fourth leading cause of death worldwide [2]
general practitioner (GP) who participated in this study decided whom of their patients they considered suitable for a telepulmonology consult (TPC)
In total 1.958 TPCs of 1.828 patients were sent by 158 GPs and answered by 32 pulmonologists between April 2009 and November 2012
Summary
Chronic Obstructive Pulmonary Disease (COPD) is a chronic lung disorder characterized by a not fully reversible airflow limitation that is usually progressive [1] and constitutes the fourth leading cause of death worldwide [2]. In the Netherlands the reported prevalence of diagnosed COPD is 1.8% in men and 1.6% in women [3]. Spirometry is a lung function test, resulting in a graph and lung function parameters required to diagnose COPD [8]. The main reason for disagreement on diagnosis was that COPD was not diagnosed by GPs, while according to international criteria the test results indicated COPD. A study of Yawn et al likewise found disagreements between GPs and pulmonologists on the interpretation of spirometry results in 88 out of 368 tests (24%) [10]. Most common reasons for disagreement in this study were overreporting of airflow obstruction in patients with normal spirometry results by GPs, interpreting restrictive patterns in people with poor effort and diagnosing COPD in absence of spirometry results indicating COPD. As concluded by Poels et al, there is a need for ongoing support for spirometry interpretation among GPs [12]
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