Wordt spirometrie beter door nascholing?

Background: Many general practices perform spirometric tests. Although several organizations provide (refresher) courses in spirometry, it is not clear whether such courses improve the quality of spirometric testing in general practice. Method: Two courses were evaluated that were given between 2009 and 2012, the CASPIR course and a course provided by the Cohesie care group in north Limburg, the Netherlands. Experienced pulmonary function technicians evaluated a random selection of spirometric test results taken from the database of participating general practices. The primary outcome was the proportion of spirometric tests that met international ATS/ERS quality criteria, with 60% being considered the performance norm. Multilevel, multivariate logistic regression analysis was used to determine the odds ratios (OR) for differences between tests performed before and after the courses. Results: In total, 1065 tests from 29 practices were evaluated (552 tests performed in 15 practices that used the CASPIR course and 513 tests performed in 14 practices that participated in the Cohesie course). In total, 39.1% of the tests performed in the CASPIR practices met quality criteria before and 51.0% after the course (OR 1.60, 95% CI 1.12-2.30); the data for the tests performed in the Cohesie practices were 45.3% and 44.1%, respectively (OR 0.93, 95% CI 0.65-1.33). Before the CASPIR course, 2 of the 15 practices (13.3%) performed better than the performance norm; this proportion increased to 7 of 15 practices (46.7%) after the course. Before the Cohesie course, 4 of 14 practices (28.6%) performed better than the performance norm, and after the course 1 (7.1%). Conclusions: In practices that had followed the CASPIR course, there was a 12% improvement in spirometric investigations and the number of practices meeting the performance norm increased 3-fold. There was no improvement in spirometric tests in practices that followed the Cohesie course and the number of practices meeting the performance norm decreased. Structured courses in spirometry can improve the quality of spirometry in general practice, but the improvement is not always relevant.