SLIDE 1
Introduction
- Leonie Thijssing, PhD Student
- KSYOS Health Management Research & Academic Medical
Center Amsterdam
- Research revolves around telemedicine applications within
the field of respiratory medicine
Telespirometry Leonie Thijssing a,b , Job P. van der Heijden b , - - PDF document
Telespirometry Leonie Thijssing a,b , Job P. van der Heijden b , - - PDF document
Telepulmonology & Telespirometry Leonie Thijssing a,b , Job P. van der Heijden b , Niels H. Chavannes c , Christian F. Melissant d , Leonard Witkamp b , Monique W.M. Jaspers a Introduction Leonie Thijssing, PhD Student KSYOS Health
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SLIDE 3
Introduction
COPD Fourth leading cause of death worldwide Under- and misdiagnosis Spirometry
Sufficient quality Interpretation
SLIDE 4
Introduction
- Clinically significant disagreements between GP’s and
pulmonologists in 49 out of 168 tests (Kappa=0.39)1
- 20% of 1.044 patients diagnosed with COPD in primary
care, spirometry test results did not indicate COPD2
- Need for ongoing support
1P
. White, W. Wong, T. Flemin and B. Gray, Primary care spirometry : test quality and the feasibility and usefulness of specialist reporting, Br J Gen Pract 2007, 701-5
2 M. Strong, A. Green. E. Goyder, G. Miles, A.C.K. Lee, G. Basran and J. Cooke Accuracy of diagnosis
and classification of COPD in primary and specialist nurse-led respiratory care in Rotherham, UK: a cross-sectional study, Prim Care Respir J 23(2014)
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Introduction
- Telespirometry – monitoring and improving quality of
spirometry tests
- Telepulmonology – supporting GP’s in interpreting
spirometry tests (diagnosis and treatment)
SLIDE 6
Introduction
- Telespirometry
- What is the quality of the spirometry tests taken in daily primary care
practice according to pulmonologists?
- What is the interobserver agreement on diagnostic findings between
the pulmonologist and the GP/practice nurse?
- Telepulmonology
- Are GP’s helped by telepulmonology in their decision making on
diagnosis and in setting treatment plans?
- Do GP’s learn from the telepulmonology consults?
- Are unnecessary physical referrals prevented?
SLIDE 7
Methods
Biometrist Grader Pulmonologist GP Pulmonologist Telepulmonology Telespirometry
Up to 10%
Up to 2x Repsonse within 2 days
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Introduction
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SLIDE 11
Methods - Inclusion
- All GP’s in the Netherlands were eligible to start using
telepulmonology
- GP’s decided for which patients
- Routine clinical practice
- Oral informed consent
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Methods - Telepulmonology
- Four questions were posed on sending and closing the TPC:
- Q1: Without telepulmonology, would you have physically referred
this patient to the pulmonologist?
- Q2: Do you now refer this patient physically to the pulmonologist?
- Q3: ¡Did ¡you ¡learn ¡from ¡the ¡pulmonologist’s ¡response?
- Q4: ¡Are ¡you ¡and ¡your ¡patient ¡helped ¡with ¡the ¡pulmonologist’s ¡
response?
- Percentage of prevented physical referrals
- Additional referrals
- Educational effect
SLIDE 13
Results - Telespirometry
- Dec 2011-Jan 2014
- 227 telespirometry tests presented to one of 8
pulmonologists
- Quality of the spirometry test
- Good 69%
- Moderate 23%
- Bad 8%
- Kappa interobserver agreement
- n diagnostic findings 0.38
Quality
Good Moderate Bad
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Results - Telepulmonology
- April 2009 – Jan 2014
- 4.488 TPC’s sent by 342 GP’s to 43 pulmonologists
- 3.126 TPC’s answers of the GP available
- Overall decrease in physical referrals of 22%
500 1000 1500 2000 2500 3000 3500
Prior to TC Sent to prevent a physical referral Sent for advice After TC
Not physically referred Physically referred
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Results - Telepulmonology
- Did you learn from the pulmonologist’s response?
- Are you and your patient helped with the pulmonologist’s
response?
68 22 10 Yes Slightly No 72 24 4 Yes Slightly No
SLIDE 16
Discussion
- Only moderate agreement between grader and
pulmonologist (Kappa 0.38)
- Two thirds of the spirometry tests quality classified as good
- Consistent with previous studies
- Illustrating an ongoing need for support
- High percentage of TPC’s sent for advice confirms this
- 90% indicated (s)he learned
- Over 95% indicated (s)he and the patient were helped
SLIDE 17
Discussion
- Telepulmonology prevents unnecessary physical referrals
- Triaged the right patients to be physically referred
- Making the quality of spirometry tests transparent can help
in determining who could benefit from additional training
- Future research: does the combination of telespirometry
and targeted additional training increase the quality of spirometry tests?
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