Agarwal Joel, Saad Emad, Fontaine Geoffrey, Pagliardini Silvia, Dafoe William, Killian Kieran, Gibney R T Noel, Huston Jim, Vethanayagam Dilini
Department of Medicine, University of Alberta; Department of Biological Sciences, University of Alberta.
Clin Invest Med. 2019 Jan 30;41(4):E204-E210. doi: 10.25011/cim.v41i4.32224.
Pulmonary function tests (PFTs), including spirometry with and without post-bronchodilator (post-BD) testing, are frequently performed in the assessment of asthma, along with other obstructive airway disorders. Multiple publications over the past 15 years have noted that one in three physician-diagnosed asthma cases are not in fact asthma. In this quality assurance project, we assess whether PFT labs in Alberta have policies on post-BD testing, as extraneous and unnecessary use of post-BD testing can lead to wasted staff and patient time and unnecessary expenses to the health care system.
We reviewed, in collaboration with the College of Physicians and Surgeons of Alberta and Alberta Medical Association, all PFT labs in the province of Alberta (hospital-based private not-for-profit [NFP] and private for-profit [FP] labs). This health policy study of PFT labs involved identifying the proportions and regional distribution of NFP and private FP labs in the province of Alberta while assessing post-BD policies. Each PFT lab was asked for their policy regarding spirometry and asthma diagnosis from May 1 to August 31, 2017.
A total of 92 PFT labs were identified in Alberta, 74 of which were private FP (independent) labs, while 18 were private NFP (public) hospital-based labs. Policies were as follows: (i) post-BD policy existed (and if so routinely performed / not routinely done); (ii) no post-BD policy; and (iii) lab chose not to participate. All 18 hospital labs responded: 10 had no policy; six had a policy or algorithm; one did not perform post-BD testing (exercise testing) and one had multiple testing sites. Of the private FP labs, three had relevant policies and/or algorithm and 10 had none. No information was provided from 61 labs. Access to PFT labs in Northern Alberta was limited.
Lab policies surrounding post-BD testing were found to be heterogeneous in Alberta. Low response rates, despite the use of a systems approach and requests in writing and in person from FP labs, were notable. Development of a standardized policy across the province would be beneficial. Further higher-level review of the appropriateness of post-BD use in both FP and NFP PFT labs is needed.
肺功能测试（PFTs），包括使用和不使用支气管扩张剂后（post-BD）测试的肺量计检查，在评估哮喘以及其他阻塞性气道疾病时经常进行。过去15年中有多篇出版物指出，三分之一经医生诊断为哮喘的病例实际上并非哮喘。在这个质量保证项目中，我们评估艾伯塔省的肺功能测试实验室是否有关于支气管扩张剂后测试的政策，因为支气管扩张剂后测试的不当和不必要使用会导致工作人员和患者时间的浪费以及医疗保健系统的不必要开支。
我们与艾伯塔省医师和外科医生学院以及艾伯塔医学协会合作，对艾伯塔省所有的肺功能测试实验室（基于医院的私立非营利性[NFP]和私立营利性[FP]实验室）进行了审查。这项关于肺功能测试实验室的卫生政策研究包括确定艾伯塔省非营利性和私立营利性实验室的比例及区域分布，同时评估支气管扩张剂后测试政策。每个肺功能测试实验室都被要求提供其在2017年5月1日至8月31日期间关于肺量计检查和哮喘诊断的政策。
在艾伯塔省共确定了92个肺功能测试实验室，其中74个是私立营利性（独立）实验室，18个是私立非营利性（公立）基于医院的实验室。政策如下：（i）存在支气管扩张剂后测试政策（以及是否常规进行/非常规进行）；（ii）没有支气管扩张剂后测试政策；（iii）实验室选择不参与。所有18个医院实验室都做出了回应：10个没有政策；6个有政策或算法；1个不进行支气管扩张剂后测试（运动测试），1个有多个测试地点。在私立营利性实验室中，3个有相关政策和/或算法，10个没有。61个实验室未提供任何信息。艾伯塔省北部的肺功能测试实验室的可及性有限。
发现在艾伯塔省，围绕支气管扩张剂后测试的实验室政策存在差异。尽管采用了系统方法，并通过书面和亲自向营利性实验室提出请求，但回应率较低，这一点值得注意。制定全省统一的标准化政策将是有益的。需要对营利性和非营利性肺功能测试实验室中支气管扩张剂后测试使用的适当性进行进一步的高级审查。
