Practice characteristics influence spirometry use
medwireNews: Researchers in Denmark have identified general practice characteristics that influence the likelihood for spirometry upon prescription of medication for obstructive lung disease.
The team says the findings, which indicate that single-handed practices and increasing general practitioner age are associated with a decreased odds for testing, could provide potential targets for the improvement of care.
The study involved data from a national register involving 1980 general practices and 35,677 adult patients who received a prescription for the first time for obstructive lung disease in 2008.
Mette Koefoed and colleagues, from the University of Southern Denmark in Odense, found that, consistent with previous evidence of spirometry underutilization, only around a half of patients underwent the test in the year following prescription.
Partnership practices were the most likely to perform spirometry, at a 1.24-fold greater odds than single-handed practices. But among single-handed practices, those that were training practices were 40% more likely to perform spirometry – a finding that was not replicated in partnership practices.
And the team found a trend for decreasing odds for testing with increasing doctor age, with the lowest likelihood for testing among those older than 65 years, who were 67% less likely to perform spirometry than those aged 45 years and younger. This effect was particularly pronounced in partnership practices where doctors over 65 were 75% less likely to perform spirometry than their younger counterparts.
However, the team found no associations between the odds for spirometry and the number of doctors, number of patients per doctor, nor the gender of doctors.
Koefoed and colleagues note that spirometry may not be appropriate for all patients but nevertheless, as it is deemed essential for a diagnosis of obstructive lung disease, could be considered a marker for quality of care.
“The variations shown could indicate a potential room for quality improvement and further studies should be conducted to clarify this issue,” the authors write in BMC Family Practice.
“Also, assessing changes in spirometry testing over time in general practice would be relevant, as improvements have been seen in outpatient clinics in recent years,” they conclude.
medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013
By Kirsty Oswald, medwireNews Reporter