Daphne Cockwell School of Nursing, Faculty of Community Services, Ryerson University, Toronto, ON, Canada.
Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
Chest. 2022 Apr;161(4):888-905. doi: 10.1016/j.chest.2021.10.030. Epub 2021 Nov 2.
Although guidelines long have recommended objective pulmonary function testing to diagnose asthma and COPD, many primary care patients receive a clinical diagnosis of asthma or COPD without objective testing. This often leads to unnecessary treatment with associated incremental costs and side effects and delays actual diagnosis.
What are the barriers and enablers to lung function testing for asthma, COPD, or both in primary care?
We searched the literature for qualitative and quantitative studies reporting barriers, enablers, or both to in-office or out-of-office lung function testing for diagnosing asthma, COPD, or both in primary care. Two reviewers independently screened abstracts and full texts, assessed methodologic quality using the Mixed Methods Appraisal Tool, and extracted data from included studies. Identified barriers and enablers were categorized using the Theoretical Domains Framework (TDF), applying a pre-established coding manual.
We identified 7,988 unique articles, reviewed 336 full-text articles, and included 18 studies in this systematic review. Of these 18, 12 were quantitative, three were qualitative, and three used mixed methods. All 18 addressed in-office testing and 11 also addressed out-of-office testing. Barriers and enablers overlapped for asthma and COPD, and in-office and out-of-office settings. We identified more reported barriers (eg, lack of knowledge of the usefulness of spirometry) than enablers (eg, skills for performing reliable spirometry). Barriers mapped to nine (of a possible 14) TDF domains (for both in-office and out-of-office settings). Enablers mapped to three domains for in-office testing and five domains for out-of-office testing.
Barriers to objective testing for airway disease in primary care are complex and span many theoretical domains. Correspondingly, a successful intervention must leverage multiple behavior change techniques. A theory-based, multifaceted intervention to address underuse of diagnostic testing for asthma or COPD now should be developed and tested.
尽管指南长期以来一直建议进行客观的肺功能测试来诊断哮喘和 COPD，但许多初级保健患者在没有客观测试的情况下获得哮喘或 COPD 的临床诊断。这通常导致不必要的治疗，带来额外的成本和副作用，并延误实际诊断。
在初级保健中，进行肺功能测试以诊断哮喘、COPD 或两者的障碍和促进因素是什么？
我们搜索了文献，以寻找报告在初级保健中进行肺功能测试以诊断哮喘、COPD 或两者的障碍、促进因素或两者兼有的定性和定量研究。两位审查员独立筛选摘要和全文，使用混合方法评估工具评估方法学质量，并从纳入的研究中提取数据。使用理论领域框架（TDF）对确定的障碍和促进因素进行分类，应用预先建立的编码手册。
我们确定了 7988 篇独特的文章，审查了 336 篇全文文章，并在系统评价中纳入了 18 项研究。其中 12 项为定量研究，3 项为定性研究，3 项采用混合方法。所有 18 项研究均涉及门诊测试，11 项研究还涉及门诊外测试。障碍和促进因素在哮喘和 COPD 以及门诊和门诊外环境中重叠。我们发现更多报道的障碍（例如，缺乏对肺功能测定有用性的了解）而不是促进因素（例如，进行可靠肺功能测定的技能）。障碍映射到九个（可能的 14 个）TDF 域（适用于门诊和门诊外环境）。门诊测试有三个领域，门诊外测试有五个领域映射到促进因素。
在初级保健中进行气道疾病的客观测试的障碍是复杂的，跨越了许多理论领域。相应地，成功的干预措施必须利用多种行为改变技术。现在应该开发和测试一种基于理论的、多方面的干预措施，以解决对哮喘或 COPD 诊断测试的使用不足问题。
