UNDERUSE OF SPIROMETRY BY FAMILY PHYSICIANS FOR THE DIAGNOSIS OF COPD IN ITALY

1
UNDERUSE OF SPIROMETRY BY FAMILY PHYSICIANS FOR
THE DIAGNOSIS OF COPD IN ITALY

• G. Bettoncelli, G. Caramori, R. Tosatto, F.
  Arpinelli, G. Visonà,
• A. Gerace, I.M. Adcock, A. Ciaccia

2
BACKGROUND

• The Global Initiative for Chronic Obstructive
  Lung Disease (GOLD) underlines that spirometry is
  the gold standard as the most reproducible,
  standardized and objective way of measuring
  airflow limitation in the diagnosis and
  assessment of chronic obstructive pulmonary
  disease (COPD)
• However, studies undertaken in different
  countries suggest a widespread underuse of
  spirometry by family physicians to establish the
  diagnosis of COPD (Table 1)

Precise estimates of the prevalence of
physician-diagnosed COPD in Italy are not
available in the literature.
3
AIM OF THE STUDY

• To investigate the degree of use of spirometry by
  family physicians to establish the diagnosis of
  COPD in Italy

4
METHODS

• In collaboration with the Italian Academy of
  Family Physicians (SIMG) a standardized
  questionnaire has been self-administered to a
  sample of 2425 Italian family physicians
  (representing 5 of all the Italian doctors
  involved in family practice).
• They have been chosen to cover all the Italian
  counties.

5
RESULTS (I)

• The prevalence of physician-diagnosed COPD in
  Italy is approximately 4 (Figure 1)
• 30 of family physicians in Italy do not use
  spirometry to establish the diagnosis of COPD
  (Figure 2)

6
RESULTS (II)

• The main reasons given by the family physicians
  for the failure to use spirometry are (Figure 3)
• - spirometry is not necessary for the diagnosis
  of COPD
• - there are logistical limitations to the
  patients access to lung function laboratories

7
CONCLUSIONS

• Contrary to GOLD guidelines, in Italy, as with
  other countries, spirometry is not always used in
  the diagnosis of COPD by family physicians.
• There is a clear necessity for further education
  initiatives targeted to this group of doctors.

8
Figure 1
Mean number of COPD patients for family physician
with 5001000 people
pazienti
Mean national data (s.d.) 40.5 30.9 patients
Mean number of COPD patients for family physician
with 1000-1500 people
pazienti
Mean national data (s.d.) 50.2 35.3 patients
9
Figure 2
Figuermedici
Spirometry use of family physicians in Italy for
COPD diagnosis
100
Yes 70,0
72,0
65,9
72,8
50
No 30,0
28,0
27,2
34,1
0
North
Centre
South
n.d. 105
10
Figure 3
Figuermedici
Main reasons for unuse of spirometry by family
physicians in Italy
63,3
Logistical problems
40,9
Clinical assessment is enough
0,6
It is not useful
0
20
40
60
80
medici