Diagnosing asthma in adults in primary care: a qualitative study of Australian GPs' experiences

Dennis, Sarah; Zwar, Nicholas; Marks, Guy B.

doi:10.4104/pcrj.2009.00046

Cited by 22 publications

(23 citation statements)

References 16 publications

(17 reference statements)

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“…Patient characteristics like age and gender have been shown to influence spirometry testing [4,11,12] and accuracy of diagnosis [13]. Also, some doctor and practice characteristics have been shown to influence spirometry testing; unfamiliarity with conducting or interpreting spirometry tests and spirometry being too time-consuming are reported as barriers [14-17], and practice characteristics like presence of a practice nurse and use of protocols have been reported to enhance spirometry testing [15]. Rural differences in spirometry testing have also been reported [18].…”

Section: Introductionmentioning

confidence: 99%

General practice variation in spirometry testing among patients receiving first-time prescriptions for medication targeting obstructive lung disease in Denmark: a population-based observational study

et al. 2013

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BackgroundSpirometry testing is essential to confirm an obstructive lung disease, but studies have reported that a large proportion of patients diagnosed with COPD or asthma have no history of spirometry testing. Also, it has been shown that many patients are prescribed medication for obstructive lung disease without a relevant diagnosis or spirometry test registered. General practice characteristics have been reported to influence diagnosis and management of several chronic diseases. However, these findings are inconsistent, and it is uncertain whether practice characteristics influence spirometry testing among patients receiving medication for obstructive lung disease. The aim of this study was therefore to examine if practice characteristics are associated with spirometry testing among patients receiving first-time prescriptions for medication targeting obstructive lung disease.MethodsA national register-based cohort study was performed. All patients over 18 years receiving first-time prescriptions for medication targeting obstructive lung disease in 2008 were identified and detailed patient-specific data on sociodemographic status and spirometry tests were extracted. Information on practice characteristics like number of doctors, number of patients per doctor, training practice status, as well as age and gender of the general practitioners was linked to each medication user.ResultsPartnership practices had a higher odds ratio (OR) of performing spirometry compared with single-handed practices (OR 1.24, CI 1.09-1.40). We found a significant association between increasing general practitioner age and decreasing spirometry testing. This tendency was most pronounced among partnership practices, where doctors over 65 years had the lowest odds of spirometry testing (OR 0.25, CI 0.10-0.61). Training practice status was significantly associated with spirometry testing among single-handed practices (OR 1.40, CI 1.10-1.79).ConclusionSome of the variation in spirometry testing among patients receiving first-time prescriptions for medication targeting obstructive lung disease was associated with practice characteristics. This variation in performance may indicate a potential for quality improvement.

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Section: Introductionmentioning

confidence: 99%

General practice variation in spirometry testing among patients receiving first-time prescriptions for medication targeting obstructive lung disease in Denmark: a population-based observational study

et al. 2013

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“…One hypothesis could be that women with education and careers are too busy and not interested in a time-consuming diagnostic process despite it being free of charge. Patients who seem uninterested in further diagnostic examination may not have spirometry offered or they may decline coming to follow-up consultations [29]. …”

Section: Discussionmentioning

confidence: 99%

Influence of socioeconomic and demographic status on spirometry testing in patients initiating medication targeting obstructive lung disease: a population-based cohort study

et al. 2013

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BackgroundSocioeconomic status is known to influence the prevalence, severity and mortality of obstructive lung diseases, but it is uncertain whether it affects the use of diagnostic spirometry in patients initiating treatment for these conditions. The objective of this paper was to examine a possible association between education, income, labour market affiliation, cohabitation status and having spirometry performed when initiating medication targeting obstructive pulmonary disease.MethodsWe conducted a population-based cohort study. Danish national registers were linked, retrieving data on prescriptions, spirometry testing, socioeconomic and demographic variables in all first time users of medication targeting obstructive lung disease in 2008.ResultsA total of 37,734 persons were included and approximately half of the cohort had spirometry performed. Among medication users under 65 years of age, being unemployed was significantly associated with reduced odds of having spirometry performed, the strongest association was seen in men (OR = 0.82, CI = 0.73-0.91). Medium income was associated with increased odds of having spirometry performed in men (OR = 1.18, CI = 1.06-1.30) and high educational level (>12 years) was associated with reduced odds of having spirometry performed in women (OR = 0.86, CI = 0.78-0.94). Cohabitation status was not associated with having spirometry performed. Among medication users over 65 years of age, living alone was associated with reduced odds of having spirometry performed among men (OR = 0.78, CI = 0.69-0.88).ConclusionSocial inequity in spirometry testing among patients initiating medication targeting obstructive lung disease was confirmed in this study. Increased focus on spirometry testing among elderly men living alone, among the unemployed and among women with higher education is required when initiating medication.

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“…Further, many projects conducted in research networks are not dependent on a representative study sample. Both PBRNs have conducted qualitative studies 21 ‐ 23 and pilot studies that did not require representative sampling.…”

Section: Discussionmentioning

confidence: 99%

How generalisable are results of studies conducted in practice‐based research networks? A cross‐sectional study of general practitioner demographics in two New South Wales networks

Magin

Marshall

Goode

et al. 2011

Medical Journal of Australia

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Objective: To compare the demographics of general practitioners in two practice‐based research networks (PBRNs) and to explore the generalisability of research findings from these PBRNs. Design, setting and participants: Cross‐sectional questionnaire‐based study of two geographically‐based PBRNs — Hunter New England Central Coast Network of Research General Practices (NRGP) and Primary Healthcare Research Network‐General Practice (PHReNet‐GP) — during August–September 2010. All 183 GP members of both PBRNs were invited to participate; of these, 140 (77%) participated. Main outcome measures: GPs’ demographics, use of languages other than English in consultations, and previous participation in research. Practices’ use of practice nurses. Socioeconomic status and rurality or urbanicity of practice location. Results: Compared with PHReNet‐GP GPs, NRGP GPs were more likely to work in a practice employing a practice nurse (100% v 53.8%; 95% CI for difference, 30.5%–61.8%; P < 0.001), worked in larger practices (2.9 more full‐time‐equivalent GPs per practice; 95% CI, 2.1–3.6; P < 0.001), and were less likely to work in a major city (33.7% v 89.7%; 95% CI for difference, 42.8%–69.3%; P < 0.001). NRGP GPs also worked in practices with a different spectrum of socioeconomic disadvantage, and were less likely to have been involved in research as a researcher (35.4% v 76.9%; 95% CI for difference, 25.3%–57.8%; P < 0.001). Fewer NRGP GPs consulted in languages other than English (8.9% v 64.1%; 95% CI for difference, 39.1%–71.2%; P < 0.001). There were also differences between these and national general practice statistics. Conclusions: These results suggest possible lack of generalisability of findings from some types of studies conducted in single PBRNs. In such circumstances, collaboration of PBRNs may produce more generalisable results.

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Diagnosing asthma in adults in primary care: a qualitative study of Australian GPs' experiences

Cited by 22 publications

References 16 publications

General practice variation in spirometry testing among patients receiving first-time prescriptions for medication targeting obstructive lung disease in Denmark: a population-based observational study

General practice variation in spirometry testing among patients receiving first-time prescriptions for medication targeting obstructive lung disease in Denmark: a population-based observational study

Influence of socioeconomic and demographic status on spirometry testing in patients initiating medication targeting obstructive lung disease: a population-based cohort study

How generalisable are results of studies conducted in practice‐based research networks? A cross‐sectional study of general practitioner demographics in two New South Wales networks

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