Impact of a spirometry expert system on general practitioners' decision-making

¹ General Practitioner, Radboud University Nijmegen Medical Centre, Dept of General Practice (117), PO box 9101, 6500 HB, Nijmegen, The Netherlands: Fax: ++31 24 354 18 62 E-mail: p.j.p.poels@hag.umcn.nl
² Senior researcher, Radboud University Nijmegen Medical Centre, Dept of General Practice (117), PO box 9101, 6500 HB, Nijmegen, The Netherlands: Fax: ++31 24 354 18 62 E-mail: t.schermer@hag.umcn.nl
³ Radboud University Nijmegen Medical Centre, Dept of General Practice (117), PO box 9101, 6500 HB, Nijmegen, The Netherlands: Fax: ++31 24 354 18 62 E-mail: d.schellekens@hag.umcn.nl
⁴ Statistician, Radboud University Nijmegen Medical Centre, Department of General Practice (117), PO box 9101, 6500 HB, Nijmegen, The Netherlands: Fax: ++31 24 354 18 62 E-mail: r.akkermans@ives.umcn.nl
⁵ Professor of Medical Informatics, Radboud University Nijmegen Medical Centre, Dept of Medical Informatics (152), PO box 9101, 6500 HB, Nijmegen, The Netherlands: Fax: ++31 24 361 3504 E-mail: p.devriesrobbe@mi.umcn.nl
⁶ General Practitioner, 17 Bedford Park Avenue, Richmond Hill, ON L4C 2N9, Ontario, Canada: Fax: 905-884-1195 E-mail: FOR4KIDS@sympatico.ca
⁷ General Practitioner, Radboud University Nijmegen Medical Centre, Dept Postgraduate Training (166), PO box 9101, 6500 HB, Nijmegen, The Netherlands: Fax: ++31 024 361 95 53 E-mail: b.bottema@voha.umcn.nl
⁸ Professor of General Practice, Radboud University Nijmegen Medical Centre, Dept of General Practice (117), PO box 9101, 6500 HB, Nijmegen, The Netherlands: Fax: ++31 24 354 18 62 E-mail: c.vanweel@hag.umcn.nl

	Abstract

This study assessed the impact of computerised spirometry interpretation expert support on the diagnostic achievements of general practitioners (GPs), and on GPs' decision-making in diagnosing chronic respiratory disease.

We performed a cluster-randomised controlled trial in 78 GPs who completed 10 standardised paper case descriptions each. Intervention consisted of support for GPs' spirometry interpretation either by an expert system (expert support group) or by sham information (control group). Agreement of GPs' diagnoses were compared with an expert panel judgement, which served as the primary outcome. Secondary outcomes were additional diagnostic test rates, width of differential diagnosis, certainty of diagnosis, estimated severity of disease, referral rate, and medication or non-medication changes. Effects were expressed as odds ratios (OR) with 95% confidence intervals.

There were no differences between the expert support and the control group in the agreement between GP and expert panel diagnosis of COPD (OR=1.08 [95% CI 0.70-1.66]), asthma (OR=1.13 [95% CI 0.70-1.80]), and absence of respiratory disease (OR=1.32 [95% CI 0.61-2.86]). A higher rate of additional diagnostic tests was observed in the expert support group (OR=2.5 [95% CI 1.17-5.35]).

Computerised spirometry expert support had no detectable benefit on GPs' diagnostic achievements and decision-making process when diagnosing chronic respiratory disease.

This article has been cited by other articles:

				P. Calverley Fulfilling the promise of primary care spirometry Eur. Respir. J., January 1, 2008; 31(1): 8 - 10. [Full Text] [PDF]