Pulmonary Service, Research Unit, San Pedro de Alcántara Hospital, Instituto de Salud Carlos III, Madrid, Spain.
Eur Respir J. 2011 Apr;37(4):911-8. doi: 10.1183/09031936.00011510. Epub 2010 Jul 22.
Spirometry is essential for the diagnosis and management of common respiratory diseases. However, its use and quality are low in primary care. An important reason for this is the technical difficulty in performing conventional spirometry. If high-quality spirometry could be performed online, from the pulmonary function laboratory in hospitals, most of the technical problems could be solved. The aim of the present study was to compare spirometries performed online by remote technicians with conventional spirometry. This was a controlled, randomised crossover study of 261 patients referred from primary care centres for pulmonary consultation. They were randomised to undergo either conventional or online spirometry. The technician, located remotely, controlled the spirometer computer. Using a teleconference link, the technician guided the patient through the spirometry. The comparison between conventional and online spirometries was performed on intention to treat and per protocol bases for spirometric values and quality criteria. Agreement between the two spirometric methods was assessed with a Bland-Altman plot. A subpopulation of off-range patients was also characterised. Finally, intra- and interobserver agreement was evaluated using the intraclass correlation coefficient. No clinically significant differences were seen between the online and conventional spirometric values in both the intention to treat and per protocol analyses. The agreement in Bland-Altman analysis was poorer for intention to treat than for the per protocol analysis. The latter had a lower percentage of off-range patients and high agreement to determine abnormal spirometry in the off-range group. Conventional spirometry had a higher percentage of patients with spirometric quality criteria although the quality criteria difference was only 5.9%, when both procedures were the first to start. Very good agreement was found between intra- and interobserver reliability. Spirometry performed online from a hospital can be an adequate alternative to conventional spirometry for primary care centres.
肺量测定对于常见呼吸系统疾病的诊断和管理至关重要。然而，在基层医疗保健中，其使用和质量都很低。造成这种情况的一个重要原因是常规肺量测定技术难度大。如果能够在医院的肺功能实验室在线进行高质量的肺量测定，那么大部分技术问题都可以得到解决。本研究的目的是比较远程技术员在线进行的肺量测定与常规肺量测定。这是一项针对 261 名从基层医疗保健中心转诊至肺科咨询的患者的对照、随机交叉研究。他们被随机分配进行常规或在线肺量测定。技术员远程控制肺量计计算机。通过电话会议链接，技术员指导患者进行肺量测定。根据意向治疗和方案进行肺量测定值和质量标准的比较。两种肺量测定方法之间的一致性通过 Bland-Altman 图进行评估。还对超出范围的患者亚群进行了特征描述。最后，使用组内相关系数评估了内部和内部观察者之间的一致性。在意向治疗和方案分析中，两种肺量测定方法的在线和常规肺量测定值之间均未观察到临床显著差异。Bland-Altman 分析中的一致性在意向治疗分析中比在方案分析中差。后者的超出范围患者比例较低，并且在超出范围的组中确定异常肺量测定的一致性较高。尽管常规肺量测定的质量标准差异仅为 5.9%，但首次进行两种程序时，常规肺量测定的患者比例较高。内部和内部观察者之间的可靠性非常一致。从医院在线进行肺量测定可以作为基层医疗保健中心常规肺量测定的一种适当替代方法。
