| More and more general practitioners (GPs) use spirometry in their daily practice. At this time, there is sufficient reason to presume that, after a single postgraduate training program without any further support, most GPs have insufficient knowledge and ability to assure valid interpretation of their spirometry tests. Therefore, some kind of continuous diagnostic expert support with regard to spirometry interpretation by GPs is advisable. The problem formulation for the study proposed is: "Does implementation of spirometry expert support (either by a computerized expert system or a local working agreement between GPs and respiratory consultants) cause changes in diagnoses and quality and efficiency of medical care in subjects with chronic respiratory morbidity managed in general practice?". In order to address this issue, two separate experiments with different study designs are proposed. The first study (n=62 GPs) is an "in-depth" study of the GPs decision making process with regard to spirometry, and the impact of a computerized expert system on this process. The second study (n=39 general practices) is a pragmatic randomized controlled implementation study evaluating two realistic modes of spirometry expert support (i.e., a computerized expert system or a working agreement between GPs and respiratory consultants). Overall, the two studies will provide us with more insight into the (cost-)effectiveness and feasibility of spirometry expert support for GPs. |
