Original Articles
Spirometry in Primary Care in Navarre, Spain
Javier Huetoa,
, Pilar Cebolleroa, Idoya Pascaa, José Antonio Cascantea, Víctor Manuel Eguíaa, Francisco Teruelb, Manuel Carpinteroc
Corresponding author
jhuetope@cfnavarra.es
Correspondence: Dr. J. Hueto. Sección de Neumología. Hospital Virgen del Camino. Irunlarrea, 4. 31008 Pamplona. Navarra. España
Correspondence: Dr. J. Hueto. Sección de Neumología. Hospital Virgen del Camino. Irunlarrea, 4. 31008 Pamplona. Navarra. España
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"apellidos" => "Menezes" ] 11 => array:1 [ "colaborador" => "on behalf of the PLATINO work group" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212906605405?idApp=UINPBA00003Z" "url" => "/15792129/0000004200000007/v1_201305150248/S1579212906605405/v1_201305150248/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Articles</span>" "titulo" => "Spirometry in Primary Care in Navarre, Spain" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "326" "paginaFinal" => "331" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Javier Hueto, Pilar Cebollero, Idoya Pasca, José Antonio Cascante, Víctor Manuel Eguía, Francisco Teruel, Manuel Carpintero" "autores" => array:7 [ 0 => array:5 [ "preGrado" => "Dr." "nombre" => "Javier" "apellidos" => "Hueto" "email" => array:1 [ 0 => "jhuetope@cfnavarra.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "Pilar" "apellidos" => "Cebollero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 2 => array:3 [ "nombre" => "Idoya" "apellidos" => "Pasca" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 3 => array:3 [ "nombre" => "José Antonio" "apellidos" => "Cascante" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 4 => array:3 [ "nombre" => "Víctor Manuel" "apellidos" => "Eguía" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 5 => array:3 [ "nombre" => "Francisco" "apellidos" => "Teruel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] ] 6 => array:3 [ "nombre" => "Manuel" "apellidos" => "Carpintero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Sección de Neumología, Hospital Virgen del Camino, Pamplona, Navarra, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Centro de Salud de Salazar, Ezcároz, Navarra, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] 2 => array:3 [ "entidad" => "Centro de Salud de Mendillorri, Pamplona, Navarra, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence: Dr. J. Hueto. Sección de Neumología. Hospital Virgen del Camino. Irunlarrea, 4. 31008 Pamplona. Navarra. España" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2005-11-07" "fechaAceptado" => "2005-11-15" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec154426" "palabras" => array:4 [ 0 => "Spirometry" 1 => "Primary care" 2 => "Use" 3 => "Quality of health care" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec154427" "palabras" => array:4 [ 0 => "Espirometría" 1 => "Atención primaria" 2 => "Utilización" 3 => "Calidad" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">To analyze the use and quality of spirometry in primary care settings in Navarre, Spain.</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">A questionnaire was completed simultaneously by professionals responsible for spirometry in all of the primary health care centers in Navarre. Data were collected on availability, model of spirometer, frequency of use, calibration, methods, personnel responsible for testing, and training of personnel. Then, baseline spirometry without a bronchodilator test was performed in 171 patients in their primary health care center and then the test was repeated on the same day in a hospital pneumology department. Spirometry was supervised by 2 pneumologists who jointly assessed the acceptability of the flow-volume curves. The quality of spirometry was assessed according to the recommendations of the American Thoracic Society and the interpretation of spirometry results according to the criteria of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR).</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">A total of 90.9% of primary health care centers in Navarre have a spirometer, although 22% of those spirometers have never been used. Only 2 centers performed between 10 and 20 spirometry tests per week and none performed more than 20. In 96% of primary health care centers the spirometers were not regularly calibrated. The professionals who performed spirometry were not dedicated for that task in 51.2% of cases, and the mean period of supervised training was 10 hours. When comparisons were made between the mean values obtained in the primary care centers and the pneumology department, statistically significant differences were detected for forced vital capacity (<span class="elsevierStyleItalic">P</span><.0001) and forced expiratory volume in the first second (<span class="elsevierStyleItalic">P</span>=.0002). Significant differences were also found between the flow-volume curves performed in the 2 different care settings for the initial and end portions of the curve as well as for the slope. The criteria for reproducibility recommended by the American Thoracic Society were not met in 76% of cases for forced vital capacity and 39.7% of cases for forced expiratory volume in the first second. Incorrect functional diagnosis occurred in 39.7% of spirometry tests and there was a tendency in the primary care settings to falsely diagnose patterns as restrictive and to inadequately classify the severity of obstruction.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Despite the fact that spirometers are available in the majority of primary health care centers in Navarre, we found a marked underuse of these devices and little compliance with recommendations for the use of spirometry. Furthermore, the quality of the measurements performed in this care setting was very low.</p>" ] "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Analizar la utilización y calidad de la espirometría por parte de atención primaria en Navarra.</p> <span class="elsevierStyleSectionTitle">Pacientes y métodos</span><p class="elsevierStyleSimplePara elsevierViewall">Se realizó una encuesta simultánea a los profesionales responsables de las espirometrías de todos los centros de salud (CS) de Navarra recogiendo datos sobre la disponibilidad, modelo de espirómetro, frecuencia de realización, calibración, metodología, personal encargado de las pruebas y su preparación. Posteriormente a 171 pacientes, a los que se había realizado una espirometría basal sin prueba de broncodilatación en su CS, se les repitió la prueba el mismo día en el laboratorio de neumología; a la hora de la inclusión de los datos, 2 neumólogos supervisaron todas las espirometrías y valoraron conjuntamente la aceptabilidad de las curvas flujo-volumen. La calidad de las espirometrías se determinó siguiendo las recomendaciones de la American Thoracic Society y la interpretación de éstas según los criterios de la Sociedad Española de Neumología y Cirugía Torácica.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">El 90,9% de los CS de nuestra comunidad disponía de espirómetros y el 22% de ellos no los utilizaba nunca. Sólo 2 CS realizaban entre 10 y 20 espirometrías a la semana y ninguno más de 20. El 96% de los centros de atención primaria no calibraba de forma reglada los aparatos y el 51,2% de los profesionales que realizaban las espirometrías no eran fijos, con 10 h de media de aprendizaje supervisado. Se detectaron diferencias estadísticamente significativas al comparar las medias de los valores de la capacidad vital forzada y del volumen espiratorio forzado en el primer segundo obtenidos en atención primaria y en la consulta de neumología (p < 0,0001 y p = 0,0002, respectivamente); también fueron significativas las diferencias encontradas en la realización de las curvas flujo-volumen entre los 2 niveles asistenciales, tanto en su inicio como en su pendiente o en su finalización. Se pudo comprobar, en un 76% de los casos para la capacidad vital forzada y en un 39,7% para el volumen espiratorio forzado en el primer segundo, un incumplimiento de los criterios de reproducibilidad recomendados por la American Thoracic Society. Se realizaron diagnósticos funcionales erróneos en el 39,7% de las espirometrías, con una tendencia a diagnosticar patrones falsamente “restrictivos” y a clasificar inadecuadamente la gravedad de la obstrucción en atención primaria.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Pese a que la mayoría de los CS de nuestra comunidad dispone de espirómetros, hemos observado una acusada infrautilización de éstos, un escaso seguimiento de las recomendaciones para la realización de la espirometría por parte de atención primaria y escasa calidad de la efectuada en este medio asistencial.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:17 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 3 | 9 |
| 2024 October | 31 | 14 | 45 |
| 2024 September | 35 | 17 | 52 |
| 2024 August | 60 | 40 | 100 |
| 2024 July | 41 | 24 | 65 |
| 2024 June | 62 | 36 | 98 |
| 2024 May | 48 | 25 | 73 |
| 2024 April | 29 | 25 | 54 |
| 2024 March | 22 | 19 | 41 |
| 2024 February | 25 | 23 | 48 |
| 2023 March | 2 | 3 | 5 |
| 2023 February | 17 | 16 | 33 |
| 2023 January | 19 | 38 | 57 |
| 2022 December | 23 | 29 | 52 |
| 2022 November | 30 | 24 | 54 |
| 2022 October | 31 | 29 | 60 |
| 2022 September | 21 | 26 | 47 |
| 2022 August | 25 | 44 | 69 |
| 2022 July | 23 | 47 | 70 |
| 2022 June | 29 | 36 | 65 |
| 2022 May | 23 | 42 | 65 |
| 2022 April | 25 | 37 | 62 |
| 2022 March | 34 | 47 | 81 |
| 2022 February | 26 | 29 | 55 |
| 2022 January | 20 | 38 | 58 |
| 2021 December | 23 | 52 | 75 |
| 2021 November | 21 | 55 | 76 |
| 2021 October | 24 | 51 | 75 |
| 2021 September | 33 | 55 | 88 |
| 2021 August | 21 | 30 | 51 |
| 2021 July | 21 | 32 | 53 |
| 2021 June | 24 | 38 | 62 |
| 2021 May | 12 | 30 | 42 |
| 2021 April | 40 | 55 | 95 |
| 2021 March | 26 | 20 | 46 |
| 2021 February | 12 | 20 | 32 |
| 2021 January | 11 | 11 | 22 |
| 2020 December | 13 | 27 | 40 |
| 2020 November | 16 | 17 | 33 |
| 2020 October | 10 | 14 | 24 |
| 2020 September | 54 | 5 | 59 |
| 2020 August | 52 | 8 | 60 |
| 2020 July | 44 | 21 | 65 |
| 2020 June | 19 | 2 | 21 |
| 2020 May | 41 | 13 | 54 |
| 2020 April | 44 | 17 | 61 |
| 2020 March | 30 | 10 | 40 |
| 2020 February | 83 | 13 | 96 |
| 2020 January | 56 | 12 | 68 |
| 2019 December | 18 | 10 | 28 |
| 2019 November | 10 | 10 | 20 |
| 2019 October | 8 | 6 | 14 |
| 2019 September | 43 | 6 | 49 |
| 2019 August | 11 | 10 | 21 |
| 2019 July | 11 | 14 | 25 |
| 2019 June | 20 | 5 | 25 |
| 2019 May | 13 | 10 | 23 |
| 2019 April | 8 | 14 | 22 |
| 2019 March | 6 | 18 | 24 |
| 2019 February | 15 | 17 | 32 |
| 2019 January | 5 | 12 | 17 |
| 2018 December | 9 | 10 | 19 |
| 2018 November | 23 | 15 | 38 |
| 2018 October | 40 | 12 | 52 |
| 2018 September | 9 | 8 | 17 |
| 2018 May | 3 | 1 | 4 |
| 2018 April | 28 | 4 | 32 |
| 2018 March | 5 | 1 | 6 |
| 2018 February | 6 | 5 | 11 |
| 2018 January | 4 | 4 | 8 |
| 2017 December | 3 | 3 | 6 |
| 2017 November | 4 | 2 | 6 |
| 2017 October | 7 | 8 | 15 |
| 2017 September | 9 | 5 | 14 |
| 2017 August | 14 | 8 | 22 |
| 2017 July | 2 | 3 | 5 |
| 2017 June | 5 | 5 | 10 |
| 2017 May | 8 | 7 | 15 |
| 2017 April | 7 | 1 | 8 |
| 2017 March | 4 | 1 | 5 |
| 2017 February | 1 | 3 | 4 |
| 2017 January | 5 | 0 | 5 |
| 2016 December | 4 | 3 | 7 |
| 2016 November | 14 | 11 | 25 |
| 2016 October | 18 | 10 | 28 |
| 2016 September | 15 | 7 | 22 |
| 2016 August | 11 | 3 | 14 |
| 2016 July | 7 | 2 | 9 |
| 2016 May | 1 | 0 | 1 |
| 2016 March | 1 | 0 | 1 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 31 | 7 | 38 |
| 2015 September | 39 | 7 | 46 |
| 2015 August | 38 | 12 | 50 |
| 2015 July | 28 | 8 | 36 |
| 2015 June | 27 | 3 | 30 |
| 2015 May | 36 | 7 | 43 |
| 2015 April | 28 | 10 | 38 |
| 2015 March | 34 | 5 | 39 |
| 2015 February | 20 | 4 | 24 |
| 2015 January | 27 | 4 | 31 |
| 2014 December | 21 | 5 | 26 |
| 2014 November | 26 | 4 | 30 |
| 2014 October | 31 | 7 | 38 |
| 2014 September | 26 | 11 | 37 |
| 2014 August | 24 | 10 | 34 |
| 2014 July | 37 | 8 | 45 |
| 2014 June | 42 | 10 | 52 |
| 2014 May | 49 | 11 | 60 |
| 2014 April | 46 | 8 | 54 |
| 2014 March | 40 | 9 | 49 |
| 2014 February | 41 | 8 | 49 |
| 2014 January | 35 | 8 | 43 |
| 2013 December | 33 | 6 | 39 |
| 2013 November | 26 | 5 | 31 |
| 2013 October | 37 | 6 | 43 |
| 2013 September | 40 | 7 | 47 |
| 2013 August | 27 | 7 | 34 |
| 2013 July | 48 | 13 | 61 |
| 2013 June | 35 | 7 | 42 |
| 2013 May | 33 | 3 | 36 |
| 2013 April | 31 | 7 | 38 |
| 2013 March | 5 | 3 | 8 |
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