To obtain a live assessment, each participating patient was asked to visit a pulmonologist immediately after a regular spirometry and standardised history taking was completed by the lung function assistant of the asthma/COPD service. During this consultation, the pulmonologist himself did the history taking, examined the patient, and used a copy of the spirometry test to assess the diagnosis and the need for additional examinations and therapeutic advice. A regular structured assessment form was filled in; this was the live assessment. These live assessments were kept aside to be compared with the paper assessments.
How this fits in
GPs face a growing number of patients with asthma and chronic obstructive pulmonary disease (COPD) who need elaborative diagnostic procedures that many GPs find difficult to interpret. Asthma/COPD services have been developed to support GPs. Within these services, consultant pulmonologists only use written history and spirometry data to assess diagnoses and give advice. The validity of assessment reports based on written information is thus far unknown. This research shows that such reports sent by the asthma/COPD service are a valid support to the GP and may help to improve the diagnosis of asthma and COPD in primary care.
The paper assessments were performed by the consulting pulmonologists, and were based on the original spirometry and medical history data of the patients. To prevent recall bias, these original data were kept apart for at least 3 months, and mixed with the routine weekly set of assessments before they were offered to the pulmonologists for regular (paper) assessment.