RESUMEN
Forced spirometry is pivotal for diagnosis and management of respiratory diseases, but its use in primary care is suboptimal. The aim of the present study was to assess a web-based application aiming at fostering high-quality spirometry in primary care. This was a randomised controlled trial with 12 intervention primary care units (PCi) and six control units (PCc) studied over 12 months. All 34 naïve nurses (PCi and PCc) received identical training. The PCi units had access to educational material and remote expert support. Quality of spirometry and usability of the web application were assessed. We included 4,581 patients (3,383 PCi and 1,198 PCc). At baseline, quality was similar (PCi 71% and PCc 67% high-quality tests). During the study, PCi showed higher percentage (71.5%) of high-quality tests than PCc (59.5%) (p<0.0001). PCi had 73% more chance of high-quality performance than PCc. The web application was better for assessing quality of testing than the automatic feedback provided by the spirometer. Healthcare professionals' satisfaction and usability were high. The web-based remote support for primary care by specialists generated a sustained positive impact on quality of testing. The study expands the potential of primary care for diagnosis and management of patients with pulmonary diseases.
Asunto(s)
Atención Primaria de Salud/métodos , Calidad de la Atención de Salud , Telemedicina , Adulto , Anciano , Femenino , Humanos , Internet , Masculino , Persona de Mediana Edad , Espirometría/métodosRESUMEN
BACKGROUND AND OBJECTIVES: A variety of methods have been used to evaluate patients with lung cancer to define a patient cohort at high risk for postoperative mortality and respiratory complications associated with lung resection surgery. Our aim was to evaluate the utility of vibration response imaging (VRI(XP)) Operation Planning Software (O-Plan) in assessing suitability for surgical resection and for the prediction of postoperative forced expiratory volume in 1s (ppoFEV(1)). METHODS: A total of 58 subjects with lung cancer underwent evaluation prior to lung resection surgery and postoperative lung function after surgery. RESULTS: Preoperative pulmonary function tests and quantitative breath sound measurements by VRI were performed in all patients to estimate postoperative lung function. In addition, 20 patients underwent perfusion scan prior to surgery. VRI(XP) O-Plan predictions (12 pneumonectomies and 46 lobectomies) showed good correlation and concordance (Lin's coefficient) with postoperative FEV(1) (l) (r=0.865, Lin's coefficient 0.858) and FEV(1) (%) (r=0.877, Lin's coefficient 0.861) 4-6 weeks after surgery. Predicted and postoperative measured FEV(1) showed no significant differences (p>0.05). Average lung function predicted postoperative values were similar for perfusion and VRI(XP) O-Plan calculations with a correlation of 0.74 and concordance of 0.700. CONCLUSIONS: VRI(XP) O-Plan has shown high accuracy in predicting postoperative FEV(1) after lung resection surgery. Given its simplicity of operation and the non-invasive nature of VRI(XP) and O-Plan, it could be a good alternative to perfusion scan in pre-surgery assessment.