Spirometric testing in primary care is promoted by the QoF for GPs. The validity of such tests is questionable, due to numerous factors, including poor technique, machine maintenance and interpretive skills. The COPD Strategy supports the use of quality-assured spirometry in primary care. This study assesses the accuracy of primary care-based spirometry in referrals to our chest clinic and new Direct Access Pulmonary Function service.Method
An audit was conducted, comparing Spirometry performed in Primary care (various machines and various technicians) with Spirometry performed on the Masterscreen PFT (CareFusion) in Lung Function laboratory. Where appropriate, obstructive spirometry was classified using GOLD/NICE COPD guidelines.Results
37 patients identified.Results
Of the 16 that had their diagnosis changed:Results
Of all referrals which were classified as obstructive (22 patients), 64% had their GOLD severity changed:Conclusion
For patients with COPD, the cost in treating patients varies with their disease severity. A change in severity staging would significantly alter the cost of treatment for Primary Care, by influencing the appropriate choice of treatment interventions. Correct diagnosis in primary care is fundamental to appropriate treatment and referral pathways for patients with respiratory disease. This study identifies a significant difference in physiological diagnosis achieved in secondary care and supports the need for more quality-assured pulmonary function testing.