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<meta content="Walters, J.A.E." name="eprints.creators_name" />
<meta content="Hansen, E.C." name="eprints.creators_name" />
<meta content="Mudge, P." name="eprints.creators_name" />
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<meta content="Walters, E.H." name="eprints.creators_name" />
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<meta content="BACKGROUND: Guidelines advise chronic obstructive pulmonary disease (COPD) should be diagnosed and managed by using spirometry to demonstrate irreversible airflow limitation and monitor change in smokers and ex-smokers aged over 35 years. METHODS: A cross-sectional study of patients and their general practitioners investigating use of spirometry in COPD in two practices by lung function assessment, review of practice records, interviews and focus groups. RESULTS: Sixteen GPs, and 38 patients with a diagnosis of COPD participated. At diagnosis, although 72% had spirometry, this occurred in only 41% of 17 patients diagnosed by a GP; but in all 19 cases when a specialist was involved. Diagnosis often occurred late, despite all patients having previously recorded symptoms typical of COPD. General practitioners expressed a preference to diagnose COPD on clinical grounds. Although 58% of patients had recent spirometry for current management, only 32% were performed by their GP. There were organisational and technical barriers to spirometry and poor recognition of the essential role of spirometry in the diagnosis of COPD. DISCUSSION: There are a number of potentially reversible factors that hinder practice recommendations regarding the use of spirometry in general practice to diagnose and manage COPD." name="eprints.abstract" />
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<meta content="1. Abramson M, Matheson M, Wharton C, Sim M. Prevalence of respiratory symptoms related to chronic obstructive pulmonary disease and asthma among middle aged and older adults. Respirology 2002;7:325-31.
2. Ruffin R, Wilson D, Adams R, et al. A high prevalence of mild chronic obstructive pulmonary disease in a population sample. In: Thoracic Society of Australia and New Zealand Annual Scientific Meeting, Adelaide, 2003.
3. Anthonisen NR, Connett JE, Kiley JP, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1. The Lung Health Study. JAMA 1994;272:1497-505.
4. Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med 2001;163:1256-76.
5. McKenzie DK, Frith PA, Burdon JG, Town GI. The COPDX Plan: Australian and New Zealand Guidelines for the management of chronic obstructive pulmonary disease. Med J Aust 2003;178:S7-39.
6. Health Insurance Commission. Health statistics: Medicare. Available at:
www.hic.gov.au/providers/health_statistics/statistical_reporting/medicare.htm, 2004.
7. NSW Clinical Service Framework. Chronic respiratory disease. Available at:
www.health.nsw.gov.au/pubs/c/pdf/chronic_resp_vol1.pdf.
8. Gorecka D, Bednarek M, Nowinski A, Puscinska E, Goljan-Geremek A, Zielinski J. Diagnosis of airflow limitation combined with smoking cessation advice increases stop smoking rate. Chest 2003;123:1916-23.2. Ruffin R, Wilson D, Adams R, et al. A high prevalence of mild chronic obstructive pulmonary disease in a population sample. In: Thoracic Society of Australia and New Zealand Annual Scientific Meeting, Adelaide, 2003." name="eprints.referencetext" />
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<meta content="BACKGROUND: Guidelines advise chronic obstructive pulmonary disease (COPD) should be diagnosed and managed by using spirometry to demonstrate irreversible airflow limitation and monitor change in smokers and ex-smokers aged over 35 years. METHODS: A cross-sectional study of patients and their general practitioners investigating use of spirometry in COPD in two practices by lung function assessment, review of practice records, interviews and focus groups. RESULTS: Sixteen GPs, and 38 patients with a diagnosis of COPD participated. At diagnosis, although 72% had spirometry, this occurred in only 41% of 17 patients diagnosed by a GP; but in all 19 cases when a specialist was involved. Diagnosis often occurred late, despite all patients having previously recorded symptoms typical of COPD. General practitioners expressed a preference to diagnose COPD on clinical grounds. Although 58% of patients had recent spirometry for current management, only 32% were performed by their GP. There were organisational and technical barriers to spirometry and poor recognition of the essential role of spirometry in the diagnosis of COPD. DISCUSSION: There are a number of potentially reversible factors that hinder practice recommendations regarding the use of spirometry in general practice to diagnose and manage COPD." name="DC.description" />
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<h1 class="ep_tm_pagetitle">Barriers to the use of spirometry in general practice</h1>
<p style="margin-bottom: 1em" class="not_ep_block"><span class="person_name">Walters, J.A.E.</span> and <span class="person_name">Hansen, E.C.</span> and <span class="person_name">Mudge, P.</span> and <span class="person_name">Johns, D.P.</span> and <span class="person_name">Walters, E.H.</span> and <span class="person_name">Wood-Baker, R.</span> (2005) <xhtml:em>Barriers to the use of spirometry in general practice.</xhtml:em> Australian Family Physician, 34 (3). pp. 201-203.</p><p style="margin-bottom: 1em" class="not_ep_block"></p><table style="margin-bottom: 1em" class="not_ep_block"><tr><td valign="top" style="text-align:center"><a onmouseover="EPJS_ShowPreview( event, 'doc_preview_1680' );" href="http://eprints.utas.edu.au/1284/1/AFP_walters_2005.pdf" onmouseout="EPJS_HidePreview( event, 'doc_preview_1680' );"><img alt="[img]" src="http://eprints.utas.edu.au/style/images/fileicons/application_pdf.png" class="ep_doc_icon" border="0" /></a><div class="ep_preview" id="doc_preview_1680"><table><tr><td><img alt="" src="http://eprints.utas.edu.au/1284/thumbnails/1/preview.png" class="ep_preview_image" border="0" /><div class="ep_preview_title">Preview</div></td></tr></table></div></td><td valign="top"><a href="http://eprints.utas.edu.au/1284/1/AFP_walters_2005.pdf"><span class="ep_document_citation">PDF</span></a> - Requires a PDF viewer<br />213Kb</td></tr></table><div class="not_ep_block"><h2>Abstract</h2><p style="padding-bottom: 16px; text-align: left; margin: 1em auto 0em auto">BACKGROUND: Guidelines advise chronic obstructive pulmonary disease (COPD) should be diagnosed and managed by using spirometry to demonstrate irreversible airflow limitation and monitor change in smokers and ex-smokers aged over 35 years. METHODS: A cross-sectional study of patients and their general practitioners investigating use of spirometry in COPD in two practices by lung function assessment, review of practice records, interviews and focus groups. RESULTS: Sixteen GPs, and 38 patients with a diagnosis of COPD participated. At diagnosis, although 72% had spirometry, this occurred in only 41% of 17 patients diagnosed by a GP; but in all 19 cases when a specialist was involved. Diagnosis often occurred late, despite all patients having previously recorded symptoms typical of COPD. General practitioners expressed a preference to diagnose COPD on clinical grounds. Although 58% of patients had recent spirometry for current management, only 32% were performed by their GP. There were organisational and technical barriers to spirometry and poor recognition of the essential role of spirometry in the diagnosis of COPD. DISCUSSION: There are a number of potentially reversible factors that hinder practice recommendations regarding the use of spirometry in general practice to diagnose and manage COPD.</p></div><table style="margin-bottom: 1em" cellpadding="3" class="not_ep_block" border="0"><tr><th valign="top" class="ep_row">Item Type:</th><td valign="top" class="ep_row">Article</td></tr><tr><th valign="top" class="ep_row">Additional Information:</th><td valign="top" class="ep_row">Copyright 2007 Australian Family Physician. Reproduced with permission from The Royal Australian College of General Practitioners. Text and images copyright of Australian Family Physician. Permission to reproduce must be sought from the publisher, The Royal Australian College of General Practitioners.
This permission is for English reproduction only. Permission is not granted for future revisions, future editions or ancillaries of any works. Permission must be requested on a case by case basis. </td></tr><tr><th valign="top" class="ep_row">Keywords:</th><td valign="top" class="ep_row">Spirometry, primary care, COPD</td></tr><tr><th valign="top" class="ep_row">Subjects:</th><td valign="top" class="ep_row"><a href="http://eprints.utas.edu.au/view/subjects/321208.html">320000 Medical and Health Sciences > 321200 Public Health and Health Services > 321208 Primary Health Care</a><br /><a href="http://eprints.utas.edu.au/view/subjects/321027.html">320000 Medical and Health Sciences > 321000 Clinical Sciences > 321027 Respiratory Diseases</a></td></tr><tr><th valign="top" class="ep_row">ID Code:</th><td valign="top" class="ep_row">1284</td></tr><tr><th valign="top" class="ep_row">Deposited By:</th><td valign="top" class="ep_row"><span class="ep_name_citation"><span class="person_name">Dr Julia AE Walters</span></span></td></tr><tr><th valign="top" class="ep_row">Deposited On:</th><td valign="top" class="ep_row">04 Jul 2007</td></tr><tr><th valign="top" class="ep_row">Last Modified:</th><td valign="top" class="ep_row">09 Jan 2008 02:30</td></tr><tr><th valign="top" class="ep_row">ePrint Statistics:</th><td valign="top" class="ep_row"><a target="ePrintStats" href="/es/index.php?action=show_detail_eprint;id=1284;">View statistics for this ePrint</a></td></tr></table><p align="right">Repository Staff Only: <a href="http://eprints.utas.edu.au/cgi/users/home?screen=EPrint::View&eprintid=1284">item control page</a></p>
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