Medicina pulmonar y respiratoria

Are Training Programs Efficient Enough to Improve Spirometry Quality in Primary Care?

Abstract

Pilar Carmen Cebollero, Maria Carmen Bermejo, Jose Antonio Cascante, Francisco Campano, Jorge Zagaceta, Izaskun Jiménez and Javier Hueto

Objective: To analyse the spirometry situation in primary care (PC), in terms of its use as well as its quality, one decade after our first analysis and to evaluate the effectiveness of the plans instituted since then. Methodology: In the first phase, a survey of all health centres (centros de salud, CSs, in Spanish), similar to the one used in 2005, was conducted in which information was requested regarding spirometric equipment, frequency of use, calibration, and personnel training. Subsequently, 96 patients were referred from PC after having a baseline spirometry conducted at a CS. The spirometry was repeated the same morning with a similar spirometer in the pneumology laboratory. Two expert pneumologists in functionalism analysed the quality of the tests according to the ATS/ERS and SEPAR regulations and compared the results with these obtained in 2005. Results: A spirometer is available in 100% of the CSs (90.9% in 2005). Spirometries are performed in 91.8%, and in 80.3%, daily calibration is performed (4% in 2005). However, the number of spirometries remains similar to that found in our previous study and lower than desired. With respect to their quality, only 40.5% of the 96 tests analysed had sufficient quality (A, B or C in a scale from A to F). The spirometric diagnosis was wrong in 43.7% of the cases (39.7% in 2005), corresponding to an absence of agreement in 29.1% and a discrepancy in the severity in 13.5%. Conclusions: Spirometry in PC continues to be an unresolved problem in our area, and we have ascertained that exclusively training and non-continuing programmes yield insufficient results. Given the magnitude of the problem and knowledge of the existence of projects that have demonstrated their effectiveness, we believe there should be no further delay in implementing any of these strategies adapted to each area.