University of Western Ontario, St. Joseph's Health Care, London.
Can Respir J. 2012 Jul-Aug;19(4):249-54. doi: 10.1155/2012/653084.
Primary care office spirometry can improve access to testing and concordance between clinical practice and asthma guidelines. Compliance with test quality standards is essential to implementation.
To evaluate the quality of spirometry performed onsite in a regional primary care asthma program (RAP) by health care professionals with limited training.
Asthma educators were trained to perform spirometry during two 2 h workshops and supervised during up to six patient encounters. Quality was analyzed using American Thoracic Society (ATS) 1994 and ATS⁄European Respiratory Society (ERS) 2003 (ATS⁄ERS) standards. These results were compared with two regional reference sites: a primary care group practice (Family Medical Centre [FMC], Windsor, Ontario) and a teaching hospital pulmonary function laboratory (London Health Sciences Centre [LHSC], London, Ontario).
A total of 12,815 flow-volume loops (FVL) were evaluated: RAP - 1606 FVL in 472 patient sessions; reference sites - FMC 4013 FVL in 573 sessions; and LHSC - 7196 in 1151 sessions. RAP: There were three acceptable FVL in 392 of 472 (83%) sessions, two reproducible FVL according to ATS criteria in 428 of 469 (91%) sessions, and 395 of 469 (84%) according to ATS⁄ERS criteria. All quality criteria - minimum of three acceptable and two reproducible FVL according to ATS criteria in 361 of 472 (77%) sessions and according to ATS⁄ERS criteria in 337 of 472 (71%) sessions. RAP met ATS criteria more often than the FMC (388 of 573 [68%]); however, less often than LHSC (1050 of 1151 [91%]; P<0.001).
Health care providers with limited training and experience operating within a simple quality program achieved ATS⁄ERS quality spirometry in the majority of sessions in a primary care setting. The quality performance approached pulmonary function laboratory standards.
初级保健诊所的肺功能检测可改善检测的可及性，并使临床实践与哮喘指南相吻合。符合测试质量标准对于实施至关重要。
评估在区域初级保健哮喘计划（RAP）中，经过有限培训的医疗保健专业人员现场进行肺功能检测的质量。
哮喘教育者在两次 2 小时的研讨会上接受了肺功能检测培训，并在最多六次患者就诊中接受了监督。使用美国胸科学会（ATS）1994 年和 ATS/欧洲呼吸学会（ERS）2003 年（ATS/ERS）标准分析质量。将这些结果与两个区域参考站点进行比较：一个是初级保健集团实践（安大略省温莎的家庭医疗中心[FMC]），另一个是教学医院肺功能实验室（安大略省伦敦的伦敦健康科学中心[LHSC]）。
共评估了 12815 个流量-容积环（FVL）：RAP-472 次就诊中的 1606 个 FVL；参考站点-FMC 中 573 次就诊中的 4013 个 FVL；以及 LHSC 中 1151 次就诊中的 7196 个 FVL。RAP：472 次就诊中的 392 次有三个可接受的 FVL（83%），469 次就诊中有 428 次符合 ATS 标准的两个可重复的 FVL（91%），469 次就诊中有 395 次符合 ATS/ERS 标准的 FVL（84%）。所有质量标准-根据 ATS 标准，472 次就诊中的 361 次（77%）和根据 ATS/ERS 标准，472 次就诊中的 337 次（71%）有至少三个可接受和两个可重复的 FVL。RAP 符合 ATS 标准的次数多于 FMC（388 次对 573 次[68%]），但少于 LHSC（1050 次对 1151 次[91%]；P<0.001）。
在简单的质量计划中，经过有限培训和经验的医疗保健提供者在初级保健环境中的大多数就诊中实现了 ATS/ERS 质量的肺功能检测。质量表现接近肺功能实验室标准。
