Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
NPJ Prim Care Respir Med. 2020 May 15;30(1):22. doi: 10.1038/s41533-020-0177-z.
American and European societies' (ATS/ERS) criteria for spirometry are often not met in primary care. Yet, it is unknown if quality is sufficient for daily clinical use. We evaluated quality of spirometry in primary care based on clinical usefulness, meeting ATS/ERS criteria and agreement on diagnosis between general practitioners (GPs) and pulmonologists. GPs included ten consecutive spirometry tests and detailed history questionnaires of patients who underwent spirometry as part of usual care. GPs and two pulmonologists assessed the spirometry tests and questionnaires on clinical usefulness and formulated a diagnosis. In total, 149 participants covering 15 GPs were included. Low agreements were found on diagnosis between GPs and pulmonologists 1 (κ = 0.39) and 2 (κ = 0.44). GPs and pulmonologists rated >88% of the tests as clinically useful, although 13% met ATS/ERS criteria. This real-life study demonstrated that clinical usefulness of routine primary care spirometry tests was high, although agreement on diagnosis was low.
美国和欧洲社会的（ATS/ERS）肺量计标准在初级保健中常常无法满足。然而，目前尚不清楚其质量是否足以满足日常临床应用。我们根据临床实用性、符合 ATS/ERS 标准以及全科医生（GP）和肺科医生之间的诊断一致性，评估了初级保健中的肺量计质量。GP 纳入了十项连续的肺量计测试和详细的病史问卷，这些患者作为常规护理的一部分接受了肺量计检查。GP 和两名肺科医生评估了肺量计测试和问卷的临床实用性，并制定了诊断。共有 149 名参与者，包括 15 名 GP。GP 和肺科医生在诊断方面的一致性较低 1（κ=0.39）和 2（κ=0.44）。尽管只有 13%的测试符合 ATS/ERS 标准，但 GP 和肺科医生仍将>88%的测试评为具有临床意义。这项真实世界的研究表明，尽管诊断一致性较低，但常规初级保健肺量计测试的临床实用性仍然很高。
