Servei de Pneumologia, HospitalClínic, CIBER de Enfermedades Respiratorias, Universitat de Barcelona, Barcelona, Spain.
Eur Respir J. 2012 Jun;39(6):1313-8. doi: 10.1183/09031936.00168010. Epub 2011 Nov 10.
Forced spirometry is pivotal for diagnosis and management of respiratory diseases, but its use in primary care is suboptimal. The aim of the present study was to assess a web-based application aiming at fostering high-quality spirometry in primary care. This was a randomised controlled trial with 12 intervention primary care units (PCi) and six control units (PCc) studied over 12 months. All 34 naïve nurses (PCi and PCc) received identical training. The PCi units had access to educational material and remote expert support. Quality of spirometry and usability of the web application were assessed. We included 4,581 patients (3,383 PCi and 1,198 PCc). At baseline, quality was similar (PCi 71% and PCc 67% high-quality tests). During the study, PCi showed higher percentage (71.5%) of high-quality tests than PCc (59.5%) (p<0.0001). PCi had 73% more chance of high-quality performance than PCc. The web application was better for assessing quality of testing than the automatic feedback provided by the spirometer. Healthcare professionals' satisfaction and usability were high. The web-based remote support for primary care by specialists generated a sustained positive impact on quality of testing. The study expands the potential of primary care for diagnosis and management of patients with pulmonary diseases.
用力肺活量测定在呼吸疾病的诊断和管理中至关重要，但在初级保健中的应用并不理想。本研究旨在评估一种旨在促进初级保健中高质量肺活量测定的基于网络的应用程序。这是一项随机对照试验，共有 12 个干预性初级保健单位（PCi）和 6 个对照组（PCc），研究时间为 12 个月。所有 34 名未经训练的护士（PCi 和 PCc）接受了相同的培训。PCi 单位可以获得教育材料和远程专家支持。评估了肺活量测定的质量和网络应用程序的可用性。我们共纳入了 4581 名患者（3383 名 PCi 和 1198 名 PCc）。基线时，质量相似（PCi 为 71%，PCc 为 67%）。在研究期间，PCi 表现出更高比例（71.5%）的高质量测试，而 PCc 为 59.5%（p<0.0001）。PCi 具有比 PCc 高出 73%的获得高质量表现的机会。网络应用程序在评估测试质量方面优于肺活量计自动反馈提供的评估。医疗保健专业人员的满意度和可用性都很高。专家通过网络为初级保健提供的远程支持对测试质量产生了持续的积极影响。该研究扩展了初级保健在诊断和管理肺部疾病患者方面的潜力。
