Compliance with ARTP standards for diagnostic spirometry in English general practices (ID 298)
National Services for Health Improvement
Funding: The service/abstract was funded by GlaxoSmithKline UK Limited (GSK) as a Medical and Educational Goods and Services (MEGS)
Abstract
AIMObjective measurement of airflow obstruction, on a background of appropriate history and symptoms, is essential in making a diagnosis of COPD. Spirometry, measuring inter alia FEV1 and FVC, is the accepted standard practice. A multi-agency Guide to Performing Quality Assured Diagnostic Spirometry (the “ARTP Standards”) was published in 2013 [1]. Some of the standards proposed may be challenging to achieve in a general practice setting. We assessed the performance of general practices against the criteria.
METHOD
Practices in five CCGs were invited to participate. A SNOMED audit identified patients with a READ code for COPD. National Services for Health Improvement (NSHI) nurses conducted a case notes review seeking “diagnostic” (first) spirometry. This was assessed against ARTP technical standards and accepted clinical interpretation for obstructive, restrictive or normal patterns.
RESULTS
Twenty seven practices from five English CCGs participated. Of 1339 patients’ notes reviewed, 1230 had a record of spirometry being performed (92%). Full compliance with ARTP criteria was accepted in 762 cases (62%). Of these, 560 (73.5%) patients had obstruction consistent with COPD, 145 (19.0%) had normal spirometry, 44 (5.8%) demonstrated a restrictive picture and 13 (1.7%) were unclassified. Of the 468 who did not meet all ARTP criteria, 264 (56.4%) had airways obstruction, 106 (22.6%) had normal spirometry, 70 (15%) demonstrated a restrictive pattern and 28 (6%) were unclassified. Reasons for failure to classify included no VC, not reproducible, short or insufficient blows and extra breath.
CONCLUSION
The discrepancy between outcomes in the standards compliant and non-compliant groups supports more rigorous training and subsequent assessment and/or certification of quality assured spirometry. This may be more consistently achieved in PCN based diagnostic hublets.
[1] artp-spirometry.pdf (clinicalscience.org.uk)
Conflicts of interest: None.
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