Identifying airway obstruction in primary care: is there a role for physiotherapists?

BMC Primary Care

Research

Andrew S. L. Chan¹  Sriram Mahadev¹  Sally Wootton²  Nicholas Zwar³  Deborah Pallavicini⁴  Lisa Pagano⁵  Zoe McKeough⁵  Sarah Dennis⁶ 

[1] Chronic Disease Community Rehabilitation Service, Northern Sydney Local Health District, Sydney, Australia;Royal North Shore Hospital, St Leonards, Australia;Northern Clinical School, University of Sydney, Sydney, Australia;Chronic Disease Community Rehabilitation Service, Northern Sydney Local Health District, Sydney, Australia;Sydney School of Health Sciences, Faculty of Medicine and Health, Level 7, D18 - Susan Wakil Health Building, The University of Sydney, 2006, Camperdown, NSW, Australia;Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia;Sydney North Primary Health Network, St Leonards, Australia;Sydney School of Health Sciences, Faculty of Medicine and Health, Level 7, D18 - Susan Wakil Health Building, The University of Sydney, 2006, Camperdown, NSW, Australia;Sydney School of Health Sciences, Faculty of Medicine and Health, Level 7, D18 - Susan Wakil Health Building, The University of Sydney, 2006, Camperdown, NSW, Australia;Ingham Institute for Applied Medical Research, Sydney, Australia;South Western Sydney Local Health District, Liverpool, Australia;

关键词: COPD;    Primary care;    Allied health;    Diagnosis;    Spirometry;   

DOI  :  10.1186/s12875-022-01944-z

 received in 2022-03-31, accepted in 2022-12-07,  发布年份 2022

来源: Springer

【 摘 要 】

AimsTo examine the implementation of a physiotherapist-driven spirometry case finding service in primary care to identify new cases of COPD and confirm diagnosis of existing cases of COPD.MethodsFour general practices were recruited. ‘At risk’ participants (aged ≥ 40 years, current/ex-smoker) and people with ‘existing’ COPD were identified from practice databases and invited to attend an assessment with a cardiorespiratory physiotherapist in each general practice. The physiotherapist performed pre/post-bronchodilator spirometry to identify or confirm a diagnosis of COPD (FEV1/FVC < 0.7). Outcome measures included number (%) of new cases of COPD, number (%) confirmed diagnosis of COPD and number (%) of high quality spirometry assessments with accurate interpretation.ResultsOne hundred forty eight participants (mean age 70 years (SD 11.1), 57% female) attended a baseline assessment (117 ‘at risk’, 31’existing’ COPD) from 748 people invited. Physiotherapists performed 145 pre/post bronchodilator spirometry assessments. Obstruction on post-bronchodilator spirometry was confirmed in 17% (19/114) of ‘at risk’ and 77% (24/31) of ‘existing’ COPD. Majority of cases were classified as GOLD Stage II (63%, n = 27). Quality of pre/post bronchodilator spirometries for FEV1 were classified as A (68%), B (19%) and C (5%).ConclusionPhysiotherapists integrated into primary care performed high quality spirometry testing, successfully case finding ‘at risk’ patients and identifying potential misdiagnosis of obstruction in some ‘existing’ COPD cases.Trial registrationANZCTR, ACTRN12619001127190. Registered 12 August 2019 – Retrospectively registered, http://www.ANZCTR.org.au/ACTRN12619001127190.aspx

【 授权许可】

CC BY   
© The Author(s) 2022