All Title Author
Keywords Abstract

Barriers to Placement of Spirometers in Clinics Affiliated with an Academic Medical Center

DOI: 10.4236/ijcm.2012.31006, PP. 31-35

Keywords: Spirometry, Medical Education, Asthma, Systems-Based Practice

Full-Text   Cite this paper   Add to My Lib


United States physician office visits for asthma have increased since 1989, and most of these visits are to primary care physicians. The National Institutes of Health has published guidelines for asthma diagnosis and management, implementation of which is expected to result in improved care and reduced costs. Compliance with asthma guidelines has been suboptimal, especially with spirometry recommendations, and more so in primary care clinics than in specialist clinics. Noncompliance has largely been attributed to physician and patient factors. This paper describes an experience with navigation of health system barriers to implementation of spirometry encountered at three primary care clinics affiliated with an internal medicine residency program. Included are perspectives and priorities of key individuals, systems issues related to institutions, and technical issues pertaining to spirometers. Navigation of ACGME core competencies is discussed.


[1]  Centers for Disease Control and Prevention, “Vital Signs: Asthma Prevalence, Disease Characteristics, and Self-Management Education—United States, 2001-2009,” Morbidity and Mortality Weekly Report, Vol. 60, No. 17, 2011, pp. 547-552.
[2]  National Asthma Education & Prevention Program, “Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma,” National Heart, Lung, and Blood Institute, Bethesda, 2003.
[3]  National Asthma Education & Prevention Program, “Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma,” National Heart, Lung, and Blood Institute, Bethesda, 2007.
[4]  E. N. Grant, J. N. Moy, K. Turner-Roan, S. R. Daugherty and K. B. Weiss, “Asthma Care Practices, Perceptions, and Beliefs of Chicago-Area Primary-Care Physicians. Chicago Asthma Surveillance Initiative Project Team,” Chest, Vol. 116, Supplement 2, 1999, pp. 145S-154S. doi:10.1378/chest.116.suppl_2.145S
[5]  E. A. Blain and T. J. Craig, “The Use of Spirometry in a Primary Care Setting,” International Journal of General Medicine, Vol. 2, 2009, pp. 183-186.
[6]  L. C. O’Dowd, D. Fife, T. Tenhave and R. A. Panettieri, “Attitudes of Physicians toward Objective Measures of Airway Function in Asthma,” The American Journal of Medicine, Vol. 114, No. 5, 2003, pp. 391-396. doi:10.1016/S0002-9343(03)00007-X
[7]  M. G. Stewart, “Core Competencies,” 2001.
[8]  T. Eaton, S. Withy, J. E. Garrett, J. Mercer, R. M. Whitlock and H. H. Rea, “Spirometry in Primary Care Practice: the Importance of Quality Assurance and the Impact of Spirometry Workshops,” Chest, Vol. 116, No. 2, 1999, pp. 416-423. doi:10.1378/chest.116.2.416
[9]  B. Conner and A. Meng, “Pulmonary Function Testing in Asthma: Nursing Applications,” Nursing Clinics of North America, Vol. 38, No. 4, 2003, pp. 571-583. doi:10.1016/S0029-6465(03)00111-7
[10]  J. Wanger and C. G. Irvin, “Office Spirometry: Equipment Selectionand Training of Staff in the Private Practice Setting,” Journal of Asthma, Vol. 34, No. 2, 1997, pp. 93-104. doi:10.3109/02770909709075653


comments powered by Disqus