Evaluation of Spirometry Expert Support in General Practice
Evaluation of Spirometry Expert Support in General Practice
More and more general practitioners (GPs) use spirometry in their practices. At this time,
 there is sufficient reason to presume that, after a single postgraduate training program
 without any further support, most GPs have insufficient knowledge and ability to assure valid
 interpretation of their spirometry tests. Therefore, some kind of continuous diagnostic
 support with regard to spirometry interpretation by GPs is advisable. The aim of the present
 study is to assess whether implementation of spirometry expert support (either by a
 computerised expert system or a working agreement between general practitioners and
 respiratory consultants with respect to spirometry interpretation) causes changes in
 diagnosing and appropriateness and efficiency of medical care in subjects with chronic
 respiratory morbidity managed in general practice.
More and more general practitioners (GPs) use spirometry in their practices. At this time,
 there is sufficient reason to presume that, after a single postgraduate training program
 without any further support, most GPs have insufficient knowledge and ability to assure valid
 interpretation of their spirometry tests. Therefore, some kind of continuous diagnostic
 support with regard to spirometry interpretation by GPs is advisable. The problem formulation
 for the study proposed is: "Does implementation of spirometry expert support (either by a
 computerized expert system or a local working agreement between GPs and respiratory
 consultants with respect to spirometry interpretation) cause changes in diagnosing and
 quality and efficiency of medical care in subjects with chronic respiratory morbidity managed
 in general practice?". In order to address this issue, two separate studies with different
 designs are proposed. Study I (n=62 GPs) is an 'in-depth' study of the GPs' decision-making
 process with regard to spirometry, and the impact of a computerized expert system on this
 process. Study II (n=39 general practices) is a pragmatic randomised-controlled
 implementation study evaluating two realistic modes of spirometry expert support (i.e., a
 computerized expert system or a working agreement between GPs and respiratory consultants).
Inclusion Criteria:

 -  GP practices with a Windows supported electronic Patient Journal System (PJS) in a
 certain postal region in the Netherlands.

 Exclusion Criteria:

 -  GP practices without a Windows supported PJS

 -  Practices outside a certain postcode region