Schermer T R, Jacobs J E, Chavannes N H, Hartman J, Folgering H T, Bottema B J, van Weel C
Department of General Practice, University Medical Centre Nijmegen, The Netherlands.
Thorax. 2003 Oct;58(10):861-6. doi: 10.1136/thorax.58.10.861.
To investigate the validity of spirometric tests performed in general practice.
A repeated within subject comparison of spirometric tests with a "gold standard" (spirometric tests performed in a pulmonary function laboratory) was performed in 388 subjects with chronic obstructive pulmonary disease (COPD) from 61 general practices and four laboratories. General practitioners and practice assistants undertook a spirometry training programme. Within subject differences in forced expiratory volume in 1 second and forced vital capacity (DeltaFEV1 and DeltaFVC) between laboratory and general practice tests were measured (practice minus laboratory value). The proportion of tests with FEV1 reproducibility <5% or <200 ml served as a quality marker.
Mean DeltaFEV1 was 0.069 l (95% CI 0.054 to 0.084) and DeltaFVC 0.081 l (95% CI 0.053 to 0.109) in the first year evaluation, indicating consistently higher values for general practice measurements. Second year results were similar. Laboratory and general practice FEV1 values differed by up to 0.5 l, FVC values by up to 1.0 l. The proportion of non-reproducible tests was 16% for laboratory tests and 18% for general practice tests (p=0.302) in the first year, and 18% for both in the second year evaluation (p=1.000).
Relevant spirometric indices measured by trained general practice staff were marginally but statistically significantly higher than those measured in pulmonary function laboratories. Because of the limited agreement between laboratory and general practice values, use of these measurements interchangeably should probably be avoided. With sufficient training of practice staff the current practice of performing spirometric tests in the primary care setting seems justifiable.
探讨在全科医疗中进行肺量计测试的有效性。
对来自61家全科诊所和4个实验室的388例慢性阻塞性肺疾病（COPD)患者进行肺量计测试与“金标准”（在肺功能实验室进行的肺量计测试）的受试者内重复性比较。全科医生和诊所助理参加了肺量计培训项目。测量实验室测试与全科医疗测试之间一秒用力呼气容积和用力肺活量的受试者内差异（诊所测量值减去实验室测量值）。将一秒用力呼气容积重复性<5%或<200ml的测试比例作为质量指标。
第一年评估时，平均一秒用力呼气容积差异为0.069L(95%CI0.054至0.084)，用力肺活量差异为0.081L(95%CI0.053至0.109)，表明全科医疗测量值始终较高。第二年结果相似。实验室和全科医疗的一秒用力呼气容积值相差可达0.5L，用力肺活量值相差可达1.0L。第一年实验室测试中不可重复测试的比例为16%，全科医疗测试为18%(p=0.302)，第二年评估时两者均为18%(p=1.000)。
经培训的全科医疗工作人员测量的相关肺量计指标略高于肺功能实验室测量的指标，但具有统计学意义。由于实验室和全科医疗测量值之间的一致性有限，可能应避免交替使用这些测量值。通过对诊所工作人员进行充分培训，在基层医疗环境中进行肺量计测试的现行做法似乎是合理的。
