1. We have provided patients with diagnosis and
treatment advice from their lung assessments using an algorithm
It was feasible and in general well appreciated by our patients
Metting EI1,2
Van der Berg J1
Van Heijst E3
Kocks JWH1,2
Van der Molen T1,2
Introduction
Previous research by our department has shown that many asthma and COPD patients would like to have more insight in their own medical results. We think that providing patients with easy access to their medical results might enhance self management and hence improve health outcomes.
Aim
We examined the feasibility of automatically providing patients with their personal results from a lung function assessment. We also evaluated patients’ opinion about these results.
Method
Setting
We included 46 patients (20% male, mean age 61 [range 20-86] years, 41% asthma, 30% COPD) who were referred by their GP for an assessment by an Asthma/COPD-service. In this service, patients are assessed according to a strict protocol and a pulmonologist evaluates the results from the assessment through the Internet. The GP who referred the patient to the AC-service will be provided with diagnosis and treatment advice from the pulmonologist and discusses this with his patient (see figure 1).
Providing medical results and advices
In this study the involved GPs were asked to discuss the results with their patients within 3 weeks after the assessment by the AC-service. An algorithm was developed to automatically generate a results overview for patients according to the 3 formats below (see table 1). We examined the participants’ opinions and preferences with an evaluation questionnaire and compared the results with illness perceptions and disease severity.
Format 1
Format 2
Format 3
Patient rating format 1 (n=32)
Overall score: (range 5-10)**
94% understood the information in format 1
Patient rating format 2 (n=33)
Overall score: (range 2-10)**
76-79% understood the spirometry information
81% understood the CCQ/ACQ information
Patient rating format 3 (n=33)
Overall score: (range 4-10)**
91% understood the information
Diagnosis and advice
Diagnosis
Severity
Medication advice
Inhaler technique
Lifestyle advice
Link to websites with information
Spirometry
FVC, FEV1, FEV1/FVC
Reversibility
Questionnaire
Clinical COPD Questionnaire score(CCQ). Only in COPD and ACOS* patients
Asthma Control Questionnaire(ACQ) score. Only in asthma and ACOS* patients
Lung function curve
Predicted lung function curve
Patient’s lung function curve
Conclusion
This study has shown that automatically providing results from lung function tests is feasible and well appreciated by patients. Some patients got worried by the diagnostic results. Therefore extra attention is required when providing patients with their medical results.
Results (see also table 1 and 2 for an overview)
72% of the patients returned the evaluation questionnaire (n=33).
97% of participants would like to view their lung function test results again, 82% preferred to view all 3 formats.
76% considered the information to be helpful in dealing with their respiratory symptoms.
A minority of participants would like to view their results on the computer instead of on paper (21% and 76% respectively).
Information about diagnosis and disease severity caused some patients to feel anxious (respectively 18% and 15%). Especially in uncontrolled asthma patients.
50% of the patients were not informed about the results by their GP.
Perceived negative consequences of the disease were related to negative emotions experienced due to the provided assessment results (correlation: 0.374, p=0.032).
¹ University of Groningen
University Medical Center Groningen Department of General Practice
the Netherlands
² University of Groningen
University Medical Center Groningen GRIAC Research Institute Groningen the Netherlands
3 Certe integral medical diagnostic services and advice
Groningen
Question
Answer options
*=more than 1 answer option was allowed
Which word(s) best describe(s) your opinion on this information?*
Useful
46%
Pleasant
18%
Nice 6%
Interesting
36%
Frightening 0%
Puzzling 3%
Useless
What are you planning to do with this information?
Keep it
85%
Throw away
Not sure
Show it to others
Would you like to view your own medical records again in the future?
Yes
97% No
Which formats would you like to view in the future?
Format 1
Format 1+2
12%
All formats
82%
None
Do you think this information will help you cope with your respiratory symptoms?
Definitely
30%
Probably
Maybe
21%
Probably not
Definitely not
Table 1: the 3 formats of personal medical results that were provided to all patients. Below, the average score of patients for the different formats. Patients could rate each format on a scale from 1 (very poor) to 10 (excellent). 6% of the patients gave a mark below 6 (unsatisfactory ).
Scan the QR code!
Figure 1: overview of the Asthma/COPD –service assessment procedure in this study
Figure 2: picture of the results of an assessment from one of our patients
Table 2: evaluation of patients'’ opinions about the provided information (n total =33)
GRONINGEN RESEARCH INSTITUTE FOR ASTHMA AND COPD
Table 1: This table presents a comparison of individual patient diagnoses given by the pulmonologists and diagnoses predicted with the decision tree.
Diagnosis predicted by decision support tool
ACOS* n
COPD
Asthma
Other**
Total
n (%)
Correct
AC service Certe
Groningen
225
355 98 33
711 (7.6)
225 (31.6)
135
1454 68 59
1716 (18.5)
1454 (84.7)
162
101
3253
609
4125 (44.4)
3252 (78.9) 28
128
1109
1480
2745 (29.5)
1480 (53.9)
Total n (%)
550 (5.9)
2038 (21.9)
3419 (48.7)
2181 (23.5)
9297 (100)
6412 (69.0)
AC serviceSTAR
Rotterdam
152 35 2
247 (7.9)
59 (23.9) 53
452 36 6
555 (17.7)
452 (82.7) 42 32
532 78
685 (21.8)
532 (77.8)
Probable asthma 11 7
580
238
836 (26.6)
580 (69.4) 21 72
919
651
818 (26.0)
651 (50.5)
175 (5.6)
708 (22.5)
1522 (48.5)
737 (23.5)
3141 (100.0)
2044 (65.1)
* Asthma/COPD overlap syndrome, ** “Diagnosis unclear”, “indication of restriction” or “no disease”