339:
Spirometry utilization in primary care – adherence to national asthma guidelines
Sunday, March 4, 2018
South Hall A2 (Convention Center)
Jasdeep S Badwal, MD, Fadi Alkhatib
RATIONALE: Spirometry remains the standard of care in the diagnostic evaluation of patients for asthma. This study aims to describe the utilization of spirometry by primary care providers.

METHODS: Cross-sectional study using retrospective chart review of 400 adult patients with an ICD-9 coded diagnosis of asthma in the electronic medical record, split evenly between academic and private clinics affiliated with the health care institution.

RESULTS: 394 patients (mean age 52.1, range 28 to 95) met inclusion criteria (197 academic, 197 private) of which 52.8% (n=208) underwent spirometry; 56.7% (n=118) academic clinics vs. 43.3% (n=90) private clinics (p = 0.006). Spirometry was most frequently ordered as an incident study (vs. monitoring/subsequent study) in the assessment for asthma (67.3%, n=140). Among the remaining patients without spirometry (n=186), only 9.1% (n=17) had ever been referred, 59.1% (n=110) had not been referred, and history was unknown for 31.7% (n=59). Monitoring/subsequent spirometry was performed in 40.9% (n=85). Upon full review of the patient’s chart, the extractors judged that 36.8% (n=145) of patients had asthma, while the diagnosis was unclear for 52.7% of patients (n=208). A small but statistically significant minority (10.4%, n=41) was judged not to have asthma. Patients who were older, obese, or of Hispanic ethnicity were significantly more likely to have spirometry. 390 (99.0%) patients had ever been prescribed asthma medications including 208 of 208 (100%) and 182 of 186 (97.8%) patients with and without spirometry respectively.

CONCLUSIONS: Spirometry is underutilized in primary care for the diagnostic evaluation and subsequent monitoring of asthma.