Spirometry expert support in family practice: a cluster-randomised trial
Patrick J P Poels, Tjard R J Schermer, Bart P A Thoonen, Johanna E Jacobs, Reinier P Akkermans, Pieter F de Vries Robbé, Philip H Quanjer, Ben J A M Bottema, Chris van Weel, Patrick J P Poels, Tjard R J Schermer, Bart P A Thoonen, Johanna E Jacobs, Reinier P Akkermans, Pieter F de Vries Robbé, Philip H Quanjer, Ben J A M Bottema, Chris van Weel
Abstract
Aim: To assess the impact of two modes of spirometry expert support on Family physicians' (FPs') diagnoses and planned management in patients with apparent respiratory disease.
Method: A cluster-randomised trial was performed with family practices as the unit of randomisation. FPs from 44 family practices recorded their diagnosis and planned management before and after spirometry for 868 patients. Intervention consisted of spirometry interpretation support by either a chest physician or expert software. Both interventions were compared with usual care (i.e. no additional interpretation support). Change in FPs' diagnoses after spirometry served as the primary outcome. Secondary outcomes were referral rate, additional diagnostic tests, and disease management changes. Effects were expressed as percentages and Odds Ratios (OR) with 95% confidence intervals.
Results: Diagnoses changed after intervention in all groups: 47.8% (95% CI 41.8 to 53.9) for chest physician support; 45.0% (95% CI 39.5 to 50.6) for software support; and 53.3% (95% CI 47.2 to 59.4) for usual care. Differences in the proportions of changed diagnosis were not statistically significant: chest physician support versus usual care OR 0.79 (95%CI 0.49 to 1.30); software support versus usual care OR 0.72 (95% CI 0.45 - 1.15). There were no differences in secondary outcomes.
Conclusion: Neither chest physician spirometry support nor expert software spirometry support had a significant impact on FPs' diagnosis of respiratory conditions or management decisions.
Trial number: http://www.clinicaltrials.gov/ct/show/NCT00131157?order=1.
Conflict of interest statement
Dr. Thoonen has received grants from AstraZeneca, Boehringer Ingelheim, Pfizer and GSK for educational purposes, congress travels and advising functions. Dr. Jacobs has received grants from Pfizer, AstraZeneca, GSK, and the Dutch Asthma Foundation to perform scientific research. Prof. Quanjer has received university grant monies, royalties from Micro Medical for expert software, and is a consultant (quality control) for a Novartis intervention study. None of these affiliations have any bearing on the science, design of the study, nor its interpretation, best illustrated by the fact that the expert system did not come out favourably. Prof. Van Weel has received grant monies from MRC (ZonMW) and unrestricted research grants from various pharmaceutical companies.
Source: PubMed