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General practice variation in spirometry testing among patients receiving first-time prescriptions for medication targeting obstructive lung disease in Denmark: a population-based observational study.

Koefoed MM, Søndergaard J, Christensen Rd, Jarbøl DE - BMC Fam Pract (2013)

Bottom Line: Information on practice characteristics like number of doctors, number of patients per doctor, training practice status, as well as age and gender of the general practitioners was linked to each medication user.Partnership practices had a higher odds ratio (OR) of performing spirometry compared with single-handed practices (OR 1.24, CI 1.09-1.40).This variation in performance may indicate a potential for quality improvement.

View Article: PubMed Central - HTML - PubMed

Affiliation: Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark. mkoefoed@health.sdu.dk

ABSTRACT

Background: Spirometry testing is essential to confirm an obstructive lung disease, but studies have reported that a large proportion of patients diagnosed with COPD or asthma have no history of spirometry testing. Also, it has been shown that many patients are prescribed medication for obstructive lung disease without a relevant diagnosis or spirometry test registered. General practice characteristics have been reported to influence diagnosis and management of several chronic diseases. However, these findings are inconsistent, and it is uncertain whether practice characteristics influence spirometry testing among patients receiving medication for obstructive lung disease. The aim of this study was therefore to examine if practice characteristics are associated with spirometry testing among patients receiving first-time prescriptions for medication targeting obstructive lung disease.

Methods: A national register-based cohort study was performed. All patients over 18 years receiving first-time prescriptions for medication targeting obstructive lung disease in 2008 were identified and detailed patient-specific data on sociodemographic status and spirometry tests were extracted. Information on practice characteristics like number of doctors, number of patients per doctor, training practice status, as well as age and gender of the general practitioners was linked to each medication user.

Results: Partnership practices had a higher odds ratio (OR) of performing spirometry compared with single-handed practices (OR 1.24, CI 1.09-1.40). We found a significant association between increasing general practitioner age and decreasing spirometry testing. This tendency was most pronounced among partnership practices, where doctors over 65 years had the lowest odds of spirometry testing (OR 0.25, CI 0.10-0.61). Training practice status was significantly associated with spirometry testing among single-handed practices (OR 1.40, CI 1.10-1.79).

Conclusion: Some of the variation in spirometry testing among patients receiving first-time prescriptions for medication targeting obstructive lung disease was associated with practice characteristics. This variation in performance may indicate a potential for quality improvement.

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Related in: MedlinePlus

Distribution of the spirometry proportion among general practice in total numbers (N=1980).
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Figure 1: Distribution of the spirometry proportion among general practice in total numbers (N=1980).

Mentions: A total of 1980 practices and 35 677 patients were included in our analysis. Just about half of the patients had spirometry performed in the time period corresponding to 51.2% (18 263/35 677). Among general practices, the mean “spirometry proportion” was 50.8%. The distribution of the “spirometry proportion” among general practice is illustrated in Figure 1 and it demonstrates quite a large variation between practices. An overview of practice characteristics and their mean “spirometry proportion” is shown in Table 1.


General practice variation in spirometry testing among patients receiving first-time prescriptions for medication targeting obstructive lung disease in Denmark: a population-based observational study.

Koefoed MM, Søndergaard J, Christensen Rd, Jarbøl DE - BMC Fam Pract (2013)

Distribution of the spirometry proportion among general practice in total numbers (N=1980).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750517&req=5

Figure 1: Distribution of the spirometry proportion among general practice in total numbers (N=1980).
Mentions: A total of 1980 practices and 35 677 patients were included in our analysis. Just about half of the patients had spirometry performed in the time period corresponding to 51.2% (18 263/35 677). Among general practices, the mean “spirometry proportion” was 50.8%. The distribution of the “spirometry proportion” among general practice is illustrated in Figure 1 and it demonstrates quite a large variation between practices. An overview of practice characteristics and their mean “spirometry proportion” is shown in Table 1.

Bottom Line: Information on practice characteristics like number of doctors, number of patients per doctor, training practice status, as well as age and gender of the general practitioners was linked to each medication user.Partnership practices had a higher odds ratio (OR) of performing spirometry compared with single-handed practices (OR 1.24, CI 1.09-1.40).This variation in performance may indicate a potential for quality improvement.

View Article: PubMed Central - HTML - PubMed

Affiliation: Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark. mkoefoed@health.sdu.dk

ABSTRACT

Background: Spirometry testing is essential to confirm an obstructive lung disease, but studies have reported that a large proportion of patients diagnosed with COPD or asthma have no history of spirometry testing. Also, it has been shown that many patients are prescribed medication for obstructive lung disease without a relevant diagnosis or spirometry test registered. General practice characteristics have been reported to influence diagnosis and management of several chronic diseases. However, these findings are inconsistent, and it is uncertain whether practice characteristics influence spirometry testing among patients receiving medication for obstructive lung disease. The aim of this study was therefore to examine if practice characteristics are associated with spirometry testing among patients receiving first-time prescriptions for medication targeting obstructive lung disease.

Methods: A national register-based cohort study was performed. All patients over 18 years receiving first-time prescriptions for medication targeting obstructive lung disease in 2008 were identified and detailed patient-specific data on sociodemographic status and spirometry tests were extracted. Information on practice characteristics like number of doctors, number of patients per doctor, training practice status, as well as age and gender of the general practitioners was linked to each medication user.

Results: Partnership practices had a higher odds ratio (OR) of performing spirometry compared with single-handed practices (OR 1.24, CI 1.09-1.40). We found a significant association between increasing general practitioner age and decreasing spirometry testing. This tendency was most pronounced among partnership practices, where doctors over 65 years had the lowest odds of spirometry testing (OR 0.25, CI 0.10-0.61). Training practice status was significantly associated with spirometry testing among single-handed practices (OR 1.40, CI 1.10-1.79).

Conclusion: Some of the variation in spirometry testing among patients receiving first-time prescriptions for medication targeting obstructive lung disease was associated with practice characteristics. This variation in performance may indicate a potential for quality improvement.

Show MeSH
Related in: MedlinePlus