The provision of diagnostic spirometry in Primary and Community Care settings

Natalie James and Lloyd Hambridge

Background to the Project

The provision of diagnostic spirometry in Primary and Community Care settings has been severely disrupted by the COVID-19 pandemic. Spirometry has been withheld in these settings in line with National Guidance due to concerns surrounding infection prevention control, suitable facilities and equipment.

There is limited accurate data available to determine the exact number of patients who are waiting for diagnostic spirometry, however Nationally based on estimates from Clinical Commission Group databases, around 200–250 patients require diagnostic spirometry per 500,000 population. The actual number of patients in ABUHB is estimated to be considerably higher given the underlying levels of respiratory disease resulting from economic, deprivation, previous industry and environmental factors.

The impact on service delivery of not performing spirometry in Primary and Community settings includes increased waiting lists of patients pending diagnostic spirometry tests, delayed diagnosis/diagnostic uncertainty, increased demand on Accident and Emergency/ Out of Hours/ General Practice and inappropriate prescribing and treatment management.

The Project

This project proposes the delivery of spirometry through development of “spirometry hubs” in each of ABUHB 5 localities, utilising existing health board premises, with service being delivered by trained HCSW and nurses. Referrals would be in line with strict inclusion and exclusion criteria, with patients prioritised into high, medium or low risk categories depending on specific criteria.

The Primary and Community respiratory nursing team would support the hubs to deliver a Gold Standard evidence based service. General Practice and community staff will be able to attend the hubs to maintain skills and competence, or complete accredited training via local educational workshops, supervision, competency assessment and ARTP certification. This will ensure that when spirometry can be reintroduced into Primary and Community Care, staff are trained to perform and accurately interpret spirometry to support accurate diagnosis.

Anticipated benefits

  • Reduced waiting lists of patients pending diagnostic spirometry tests
  • Improved diagnosis/diagnostic certainty
  • Reduced demand on Accident and Emergency/ Out of Hours/ General Practice
  • More appropriate prescribing and treatment management