Primary Care Provider's Perceptions of Spirometry Use for Diagnosis and Management of COPD

Abstract

Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of death worldwide and requires close monitoring and follow up to prevent exacerbations that lead to hospitalizations (CDC, 2015). COPD is often underdiagnosed or misdiagnosed for asthma and also under-treated because providers are not utilizing the recommended diagnostic tool, spirometry, for patients who present with chronic respiratory symptoms (Decramer et al., 2015). The purpose of this study is to assess perceived barriers to spirometry use among primary care providers (PCP) including nurse practitioners (NP) and physician assistants (PA) within Arizona. The aim of this project is to assess for commonalities in barriers and determine practice and educational implications and areas for future research to increase knowledge about the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Guidelines so that spirometry is performed more frequently. A survey was administered to PCPs (NPs and PAs) in Arizona through medical professional organizations. Basic demographic data was collected, in addition to questions assessing practice assessment, perceived barriers to spirometry, and utilization of smoking cessation methods and COPD prevention methods. A total of 47 responses were used for the data analysis. Females accounted for 87% (n=41) of the total sample size, and males accounted for 13% (n=6). There were 89% (n=42) NPs and 11% (n=5) PAs. Only 53% (n=25) stated that they have access to a spirometer and 47% (n=22) stated they did not have access to the tool. The most common barriers to spirometry use were concerns about testing quality and accuracy (28%, n=13), cost of the tool (23%, n=11), uncertainty about interpretation (21%, n=10), and unfamiliarity (21%, n=10). Other causes include concerns for reimbursement (11%, n=6), not enough time with patient (11%, n=5), preference to send for pulmonary function tests (11%, n=5), and lastly uncertain about impact of results on clinical practice (6%, n=3). In conclusion, the results call for further practice and educational interventions to mitigate these barriers and provide better support to providers who care for those with chronic respiratory symptoms. Further research into this issue can help lead to interventions and increase knowledge about the GOLD guidelines to improve patient outcomes.