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Original Research: COPD |

Patient and Physician Factors Associated With Pulmonary Function Testing for COPDPulmonary Function Testing in COPD Diagnosis: A Population Study

Andrea S. Gershon, MD; Jeremiah Hwee, MSc; Ruth Croxford, MSc; Shawn D. Aaron, MD; Teresa To, PhD
Author and Funding Information

From the Department of Medicine (Dr Gershon), Sunnybrook Health Sciences Centre, Toronto; Institute for Clinical Evaluative Sciences (ICES) (Drs Gershon and To; Mr Hwee; and Ms Croxford), Toronto; Faculty of Medicine (Drs Gershon and To), University of Toronto, Toronto, ON, Canada; Child Health Evaluative Sciences (Drs Gershon and To), The Hospital For Sick Children (SickKids), Toronto; and Ottawa Hospital Research Institute (Dr Aaron), University of Ottawa, Ottawa, ON, Canada.

Correspondence to: Andrea S. Gershon, MD, Institute for Clinical Evaluative Sciences (ICES), G1 06, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada; e-mail: andrea.gershon@ices.on.ca


Part of this article has been presented in abstract form at the American Thoracic Society 2012 International Conference, May 18-23, 2012, San Francisco, CA (Gershon AS, Victor JC, Cascagnette P, Aaron SD, To T. Am J Respir Crit Care Med. 2012:A3712).

Funding/Support: Dr Gershon was supported by a New Investigator Award funded by team grant OTG-88591 from the Canadian Institutes of Health Research Institute of Nutrition, Metabolism and Diabetes while working on this study and is currently supported by a Physicians’ Services Incorporation Fellowship in Translational Research. Dr To is supported by The Dales Award in Medical Research from the University of Toronto (Toronto, ON, Canada). Funding for this project was made available through the Government of Ontario. This study was also supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(2):272-281. doi:10.1378/chest.13-0790
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Background:  The diagnosis of COPD is made by objectively demonstrating nonreversible airflow obstruction of the lungs. Despite this, rates of pulmonary function testing (PFT) for diagnosis remain low. It is still not known why testing is underused.

Methods:  We conducted a population study using the health administrative data of all individuals 35 years of age and older newly diagnosed with COPD in Ontario, Canada, between 2000 and 2010. Receipt of PFT during the peridiagnostic period (between 1 year before and 1 year after a diagnosis of COPD) was determined and related to patient demographic and clinical characteristics as well as primary care physician and health-care system factors.

Results:  Only 35.9% of the 491,754 Ontarians newly diagnosed with COPD during the study period received PFT. Individuals diagnosed before age 50 years or after age 80 years, those living in long-term care, and those with stroke and/or dementia were less likely to receive testing. Patients who had a medical specialist involved in their care and/or had other coexisting pulmonary disease were more likely to receive testing. Finally, older primary care physicians were less likely to order testing for their patients.

Conclusions:  Only about one-third of individuals with COPD in Ontario, Canada, received PFT to confirm their diagnosis; age, comorbidity, and physician factors appear to influence its use. Targeted strategies that address these factors could increase the rate of appropriate testing of people with suspected COPD and improve quality of COPD care.

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