Table 1

Advantages and disadvantages of different alternatives for organising spirometry in primary care

Where spirometry performed	Advantages	Disadvantages
General practice surgery	Least barriers to access	Reliability of measurements less certain
	No extra healthcare costs	Extra workload for family practices
	Least travelling distance for patients	Family practice has to build up expertise
	Minimises number of patient visits (“one-stop shop”)	Changes in practice organisation (often) necessary
	Results of spirometry integrated into first consultation
	Enables FPs to acquire expertise
Nurse-run asthma/COPD clinic	Good reliability of measurements	Extra healthcare costs
	Few access limitations	(Considerable) travelling distance for patients
	No extra workload for family practices	Timely feedback of spirometry results to family practice crucial
	No high demands on spirometry expertise in family practices
PCG-commissioned	Good reliability of measurements	Extra healthcare costs
spirometry service	Few access limitations	(Considerable) travelling distance for patients
	No extra workload for family practices	Timely feedback of spirometry results to family practice crucial
	No high demands on spirometry expertise in family practice
	Centralisation of interpretation of spirometry
Hospital-based pulmonary	Optimum reliability of measurements	Possible access limitations^#
function laboratory	No extra workload for family practices	Limited capacity next to regular tasks
	No high demands on expertise	Extra healthcare costs
	in family practice	(Considerable) travelling distance for patients
	Facilitates consultation of specialist respiratory services^#	Timely feedback of test results to family practice crucial

COPD: chronic obstructive polmonary disease; PCC: primary care group; FP: family practitioner. ^#: depending on local cooperation with secondary care chest physicians
Table modified from 10