Spirometry expert support in family practice: a cluster-randomised trial
| Autor: | P.F. de Vries Robbé, Ben Bottema, J.E. Jacobs, Reinier Akkermans, Bart Thoonen, Patrick J.P. Poels, Tjard Schermer, C. van Weel, Philip H. Quanjer |
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| Přispěvatelé: | Biochemistry, Pulmonary Medicine |
| Rok vydání: | 2009 |
| Předmět: |
Pulmonary and Respiratory Medicine
Spirometry Adult Male medicine.medical_specialty Referral Respiratory Tract Diseases Implementation Science [NCEBP 3] law.invention Randomized controlled trial law Perception and Action [DCN 1] medicine Odds Ratio Humans Diagnosis Computer-Assisted Medical diagnosis Disease management (health) Referral and Consultation Aged Original Research medicine.diagnostic_test Primary Health Care business.industry Public Health Environmental and Occupational Health Effective primary care and public health [NCEBP 7] Odds ratio Middle Aged Confidence interval Clinical trial Physical therapy Female business Family Practice |
| Zdroj: | Primary Care Respiratory Journal, 18, 189-97 npj Primary Care Respiratory Medicine, 18(3), 189-197. Nature Publishing Group Primary Care Respiratory Journal, 18, 3, pp. 189-97 |
| ISSN: | 2055-1010 1471-4418 |
| Popis: | Contains fulltext : 81520.pdf (Publisher’s version ) (Closed access) 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. |
| Databáze: | OpenAIRE |
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