Hueto Javier, Cebollero Pilar, Pascal Idoya, Cascante José Antonio, Eguía Víctor Manuel, Teruel Francisco, Carpintero Manuel
Sección de Neumología. Hospital Virgen del Camino. Pamplona. Navarra. España.
Arch Bronconeumol. 2006 Jul;42(7):326-31. doi: 10.1016/s1579-2129(06)60541-7.
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.
分析西班牙纳瓦拉地区基层医疗单位肺功能仪的使用情况及检测质量。
纳瓦拉所有基层医疗中心负责肺功能检测的专业人员同时填写一份调查问卷。收集有关肺功能仪的可用性、型号、使用频率、校准情况、方法、检测负责人及人员培训等方面的数据。然后，在171例患者的基层医疗中心进行未使用支气管扩张剂的基础肺功能检测，同一天在医院呼吸科重复该检测。肺功能检测由两名呼吸科医生监督，他们共同评估流速 - 容量曲线的可接受性。根据美国胸科学会的建议评估肺功能检测质量，并根据西班牙肺科与胸外科协会（SEPAR）的标准解读肺功能检测结果。
纳瓦拉地区90.9%的基层医疗中心拥有肺功能仪，不过其中22%的肺功能仪从未使用过。每周仅2个中心进行10至20次肺功能检测，没有一个中心的检测次数超过20次。96%的基层医疗中心的肺功能仪未定期校准。51.2%的情况下进行肺功能检测的专业人员并非专职从事此项工作，且监督培训的平均时长为10小时。当比较基层医疗中心和呼吸科所获的平均值时，发现用力肺活量（P < .0001）和第1秒用力呼气量（P = .0002）存在统计学显著差异。在两种不同医疗环境下进行的流速 - 容量曲线在曲线起始段、末端以及斜率方面也发现了显著差异。美国胸科学会推荐的重复性标准在76%的用力肺活量检测案例和39.7%的第1秒用力呼气量检测案例中未得到满足。39.7%的肺功能检测出现功能诊断错误，在基层医疗环境中存在将模式错误诊断为限制性以及对阻塞严重程度分类不当的倾向。
尽管纳瓦拉地区大多数基层医疗中心都有肺功能仪，但我们发现这些设备的使用明显不足，且很少遵循肺功能检测的相关建议。此外，在这种医疗环境下进行的测量质量非常低。
