Variability in the Performing of Spirometry and Its Consequences in the Treatment of COPD in Primary Care

Monteagudo, Mònica; Rodriguez-Blanco, Teresa; Parcet, Judith; Peñalver, Núria; Rubio, Carles; Ferrer, Montserrat; Miravitlles, Marc

doi:10.1016/S1579-2129(11)70057-X

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Abstract

Background

Several studies have dealt with the use of spirometry in the treatment of chronic obstructive pulmonary disease (COPD) in Primary Care (PC), but few have analyzed its impact on the treatment of the patient with COPD.

Objectives

To evaluate the use of spirometry in the diagnosis and follow-up of COPD patients in PC, and its impact on treatment. To analyze the variation in the performing of spirometry between PC centers.

Methodology

A multicenter, observational and cross-sectional study of COPD patients seen in PC in Catalonia (Spain) during 2004–2005. A multilevel logistic regression model was used to identify factors associated with having spirometry and to determine the variation between the different centers.

Result

Twenty-one centers, including 801 patients, participated. Only 53.2% of them had diagnostic spirometry and the mean (standard deviation) FEV1(%) was 54.8% (18%). The registers of smoking habits, complementary tests and spirometry follow-up were more common among patients who had a diagnostic spirometry available compared with those who did not. No statistically significant differences were found regarding demographic, clinical, treatment and quality of life variables between patients with and without follow-up spirometry. Significant variation was observed in the percentage of diagnostic spirometries between different PC centers (variance=0.217; p<0.001).

Conclusion

Spirometry is underused in PC and performing it during follow-up is not associated with the different treatments guidelines or with a more complete approach to the disease. There is significant variation in the performing of spirometry among PC centers.

Keywords:

Chronic obstructive pulmonary disease

Spirometry

Primary Care

Treatment

Resumen

Antecedentes

Algunos estudios han abordado el uso de la espirometría en la enfermedad pulmonar obstructiva crónica (EPOC) en Atención Primaria (AP), y pocos han analizado su impacto en el tratamiento del paciente con EPOC.

Objetivos

Valorar la utilización de la espirometría en el diagnóstico y seguimiento de los pacientes EPOC en AP y su impacto en el tratamiento. Analizar la variabilidad en la realización de espirometrías entre los centros de AP.

Metodología

Estudio multicéntrico, observacional y transversal en pacientes EPOC atendidos en AP de Catalunya (España) durante 2004–2005. Se usó un modelo de regresión logística multinivel para identificar factores asociados con tener espirometría y determinar la variabilidad entre los diferentes centros.

Resultados

Participaron 21 centros, que incluyeron 801 pacientes. Solo el 53,2% disponían de espirometría diagnóstica, la media (desviación estándar) del FEV1(%) fue 54,8% (18%). Los registros del hábito tabáquico, pruebas complementarias y espirometrías de seguimiento estuvieron más presentes entre los pacientes que disponían de espirometría diagnóstica respecto a aquellos que no la disponían. No se encontraron diferencias estadísticamente significativas respecto a variables demográficas, clínicas, tratamiento y calidad de vida entre pacientes con o sin espirometría de seguimiento. Se observó variabilidad significativa en el porcentaje de espirometrías diagnósticas entre los diferentes centros de AP (varianza=0,217; p<0,001).

Conclusión

La espirometría en AP está infrautilizada y su realización durante el seguimiento no se asocia a unas pautas distintas de tratamiento ni a un abordaje más completo de la enfermedad. Existe variabilidad significativa en la realización de espirometrías entre los centros de AP

Palabras clave:

Enfermedad pulmonar obstructiva crónica

Espirometría

Atención Primaria

Tratamiento

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