Differences in the use of spirometry between rural and urban primary care centers in Spain

Figures & data

Figure 1 Flowchart of the centers surveyed.

Table 1 Information on center resources

	Urban (n=322)	Rural (n=283)	P-value*
Number of spirometers per center	1.17 (0.4)	1.11 (0.3)	0.080
Spirometry done only in that center (%)	313 (97.2)	264 (94.0)	0.022
Spirometry done in different centers with portable spirometer (%)	3 (0.9)	8 (1.3)	0.08
Spirometry done in different centers with the spirometer of the center (%)	6 (1.9)	9 (3.2)	0.29
Average number of spirometries conducted per week	6.9 (5.7)	4.0 (4.1)	<0.001
Centers with no perceived needs regarding the performance of spirometry (%)	122 (37.9)	127 (44.9)	0.083
Centers with no perceived needs regarding interpretation (%)	218 (67.7)	203 (71.7)	0.289
Centers with specific time and schedule (%)	207 (64.2)	209 (73.9)	0.003
Centers with allocated room (%)	219 (68.2)	176 (62.2)	0.124

Notes:

* P-values between rural and urban centers are calculated by unpaired Student’s t-test or χ² test as appropriate. Data are expressed as mean (standard deviation) or absolute (relative) frequencies (%). Bold numbers mean significant statistical differences.

Table 2 Information regarding staff and training

	Urban (n=322)	Rural (n=283)	P-value*
Centers with spirometries done by a nurse (%)	320 (99.4)	271 (95.8)	0.005
Centers that received any training course for conducting spirometry (%)	268 (83.2)	243 (85.9)	0.431
Type of spirometry training course received
Theoretical and practical	207 (64.3)	201 (71.0)	0.204
Only theoretical	44 (13.7)	30 (10.6)	0.286
Only practical	57 (17.7)	38 (13.4)	0.176
Level of satisfaction with your own training (1–10)†	7.04 (1.6)	7.06 (1.7)	0.845
Centers’ interpretation done by a general practitioner (%)	316 (98.1)	272 (96.1)	0.146
Level of satisfaction with spirometries (1–10)†	7.6 (1.3)	7.8 (1.1)	0.019
Centers that received any training course for interpretation (%)	107 (33.2)	116 (41.0)	0.004

Notes:

* P-values between rural and urban centers are calculated by unpaired Student’s t-test or χ² test as appropriate. Data are expressed as mean (standard deviation) or absolute (relative) frequencies (%).

† Level of satisfaction was evaluated using a scale from 1 (lowest satisfaction) to 10 (highest satisfaction). Bold numbers mean significant statistical differences.

Table 3 Information regarding spirometer use

	Urban (n=322)	Rural (n=283)	P-value*
Estimation of percentage of spirometries not valid (%) as judged by the technician surveyed	9.7 (10.8)	9.8 (10.6)	0.994
Any previous information given to the patient (%)	282 (87.6)	246 (86.9)	0.886
Main indications
Asthma (%)	33.9 (19.5)	31.7 (19.6)	0.201
COPD (%)	47.8 (20.4)	51.6 (23.7)	0.046
Other respiratory diseases (%)	10.6 (14.4)	9.4 (14.7)	0.314

Notes:

* P-values between rural and urban centers are calculated by unpaired Student’s t-test or χ² test as appropriate. Data are expressed as absolute (relative) frequencies (%). Bold numbers mean significant statistical differences.

Abbreviation: COPD, chronic obstructive pulmonary disease.

Table 4 Information regarding the bronchodilator test

	Urban (n=322)	Rural (n=283)	P-value*
Indication to suspend inhalers before spirometry
Always (%)	297 (92.2)	260 (91.9)	0.881
Occasionally (%)	12 (3.7)	8 (2.8)	0.651
Never (%)	13 (4.0)	15 (5.3)	0.562
Percentage of patients’ test not done for not having withdrawn inhalers (%)	6.6 (12.9)	4.9 (7.9)	0.053
Which drugs do you have available for the bronchodilator test
Salbutamol (%)	299 (92.9)	270 (95.4)	0.228
Terbutaline (%)	24 (7.5)	31 (11.0)	0.157
Ipratropium (%)	12 (3.7)	22 (7.8)	0.034
Which one of them do you normally use?
Salbutamol (%)	296 (94.3)	265 (96.4)	0.251
Terbutaline (%)	15 (4.8)	7 (2.5)	0.193
Ipratropium (%)	3 (1.0)	3 (1.1)	1.000
How many inhalations you give?
Salbutamol	2.6 (0.8)	2.6 (0.8)	0.784
Terbutaline	2.3 (0.6)	2.1 (0.6)	0.200
Ipratropium	2.3 (0.7)	2.1 (0.4)	0.209
How long do you wait for the second spirometry?
10 min (%)	59 (19)	50 (18.3)	0.915
15 min (%)	149 (47.9)	117 (42.9)	0.244
20 min (%)	84 (27.0)	86 (31.5)	0.237
30 min (%)	12 (3.9)	11 (4.0)	1.000
Criterion to consider a positive bronchodilator test is increasing 12% and 200 mL (%)	117 (58.5)	74 (52.1)	0.270

Notes:

* P-values between rural and urban centers are calculated by unpaired Student’s t-test or χ² test as appropriate. Data are expressed as mean (standard deviation) or absolute (relative) frequencies (%). Bold numbers mean significant statistical differences.

Abbreviation: min, minutes.

Table 5 Information regarding spirometer features

	Urban (n=322)	Rural (n=283)	P-value*
Type of transducer
Pneumotachometer (%)	52 (16.1)	39 (13.8)	0.428
Turbine (%)	119 (37.0)	106 (37.5)	0.933
Curves only on the screen (%)	299 (92.9)	258 (91.2)	0.455
Reference values
SEPAR (%)	124 (38.5)	83 (29.3)	0.020
ERS (%)	5 (1.6)	1 (0.4)	0.222
Do not know/answer (%)	190 (59.0)	196 (69.3)	0.011

Notes:

* P-values between rural and urban centers are calculated by unpaired Student’s t-test or χ² test as appropriate. Data are expressed as absolute (relative) frequencies (%). Bold numbers mean significant statistical differences.

Abbreviations: SEPAR, Sociedad Española de Neumología y Cirugía Torácica; ERS, European Respiratory Society.

Table 6 Information regarding spirometer maintenance

	Urban (n=322)	Rural (n=283)	P-value*
Meteorological information
Automatically provided by the device (%)	153 (50.3)	121 (45.7)	0.275
Meteorological station in the room (%)	97 (31.9)	94 (35.5)	0.375
How often do you calibrate the spirometer?
Every day it is used (%)	119 (37.0)	115 (40.6)	0.551
Never (%)	32 (9.9)	26 (9.2)	0.909
Reasons for not never calibrating
Do not have the calibrating syringe (%)	8 (25.0)	10 (38.0)	0.393
The device does not require it (%)	8 (25.0)	6 (23.1)	0.946
There is a person in charge of the maintenance (%)	186 (57.8)	179 (63.3)	0.281
How often do you do maintenance?
More than once a day (%)	56 (17.4)	59 (20.8)	0.469
Once a month (%)	60 (18.6)	59 (20.8)	0.631
Use a different filter for every patient (%)	257 (79.8)	229 (80.9)	0.909

Notes:

* P-values between rural and urban centers are calculated by unpaired Student’s t-test or χ² test as appropriate. Data are expressed as absolute (relative) frequencies (%).