Why is spirometry underused in the diagnosis of the breathless patient: a qualitative study

BMC Pulmonary Medicine

Martyn R Partridge³  Susan F Smith²  Nicola J Roberts¹ 

[1] Health Economics and Health Technology Assessment, Centre for Population & Health Sciences, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK;Imperial College London, Guy Scadding Building, Royal Brompton Campus, Dovehouse Street, London, SW3 6LY, UK;Faculty Education Office (Medicine), Imperial College London, Sir Alexander Fleming Building, South Kensington Campus, London, SW7 2AZ, UK

关键词: Barriers to use;    General Practitioners;    Trainees;    Spirometry;   

Others  :  1172530
DOI  :  10.1186/1471-2466-11-37

 received in 2011-01-11, accepted in 2011-06-16,  发布年份 2011

【 摘 要 】

Background

Use of spirometry is essential for the accurate diagnosis of respiratory disease but it is underused in both primary and specialist care. In the current study, we have explored the reasons for this underuse.

Methods

Five separate focus groups were undertaken with final year medical undergraduates, junior hospital doctors, general practitioners (GPs) and specialist trainees in respiratory medicine. The participants were not told prior to the session that we were specifically interested in their views about spirometry but discussion was moderated to elicit their approaches to the diagnosis of a breathless patient, their use of investigations and their learning preferences.

Results

Undergraduates and junior doctors rarely had a systematic approach towards the breathless patient and tended, unless prompted, to focus on the emergency room situation rather than on patients with longer term causes of breathlessness. Whilst their theoretical knowledge embraced the possibility of a non-respiratory cause for breathlessness, neither undergraduates nor junior doctors spontaneously mentioned the use of spirometry in the diagnosis of respiratory disease. When prompted they cited lack of familiarity with the use and location of equipment, and lack of encouragement to use it as being major barriers to utilization. In contrast, GPs and specialist respiratory trainees were enthusiastic about its use and perceived spirometry as a core element of the diagnostic workup.

Conclusions

More explicit training is needed regarding the role of spirometry in the diagnosis and management of those with lung disease and this necessitates both practical experience and training in interpretation of the data. However, formal teaching is likely to be undermined in practice, if the concept is not strongly promoted by the senior staff who act as role models and trainers.

【 授权许可】

   
2011 Roberts et al; licensee BioMed Central Ltd.

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