Tough spirometry targets in QOF would improve care

Requirements for GPs to conduct spirometry in line with British Thoracic Society (BTS) guidelines should be included in QOF, public health researchers have urged.

The call follows research suggesting that spirometry is carried out to BTS standards for under a third of patients with COPD.

Researchers led by Mark Strong, clinical lecturer in public health at the University of Sheffield, examined records from 3,217 patients with COPD from 38 practices in Rotherham, South Yorkshire.

They calculated the proportion of patients whose spirometry met BTS standards, which require three consistent readings, two within 5 per cent or 100ml of one another.

Just 31 per cent of clinical spirometry records had been conducted in line with these standards, researchers found.

'Spirometry plays a central role in the diagnosis and management of COPD and is recommended by NICE,' they said. 'We feel therefore that this is strong justification for supporting primary care clinicians to conduct spirometry to nationally agreed standards.'

Dr Strong told GP: 'If GPs are to be rewarded for spirometry, it would be good if it was done to a standard, and the BTS guidelines are the national standard.'

Swindon GP Dr Anthony Crockett pointed out that the severity of COPD as assessed clinically and assessed using spirometry may not correlate well. 'COPD is a clinical diagnosis confirmed by spirometry,' he said.

Dr Crockett added that the lesson for GPs from the research was to pay attention to quality and try to obtain good training. 'However,' he added, 'this is a new skill taken on by GPs over the past few years so encouragement rather than bald criticism is more fruitful.'

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