Telepulmonology: effect on quality and efficiency of care

SummaryBackgroundInterpreting spirometry results has proven challenging in primary care practice, among others potentially leading to under- and misdiagnosis of COPD. In telepulmonology a general practitioner (GP) digitally consults a pulmonologist to support the interpretation of spirometry results. This study assessed the effect of telepulmonology on quality and efficiency of care.MethodsQuality of care was measured by five indicators, among others the percentage of TelePulmonology Consultations (TPCs) sent by GPs for advice, percentage of those TPCs resulting in a physical referral, and educational effect of telepulmonology as experienced by GPs. Efficiency was defined as the percentage of prevented unnecessary physical referrals of patients to the pulmonologist.ResultsBetween April 2009 and November 2012 1.958 TPCs were sent by 158 GPs to 32 pulmonologists. Sixty-nine percent of the TPCs were sent for advice. Based on the advice of the pulmonologist 18% of these TPCs led to a physical referral of patients who would not have been referred without telepulmonology. Thirty-one percent of the TPCs were intended to prevent a physical referral, 68% of these actually prevented a physical referral to a pulmonologist.ConclusionThe results show telepulmonology can contribute to quality of care by supporting GPs and can additionally prevent unnecessary physical referrals

Telepulmonology in the Netherlands: effect on quality and efficiency of care

In telepulmonology a general practitioner (GP) digitally consults a local pulmonologist. This study assessed the effect of telepulmonology on quality and efficiency of care. Efficiency of care was measured as the percentage of prevented physical referrals. Quality of care was measured using 5 indicators. Thirty-one percent of the TelePulmonology Consultations (TPCs) were sent to prevent a physical referral, the other TPCs were sent to ask for advice of the pulmonologist. Sixty-eight percent of the TPCs sent to prevent a physical referral indeed prevented a physical referral. Eighteen percent of the TPCs sent for advice resulted in a physical referral on advice of the pulmonologist. These patients would not have been referred without telepulmonolog

Nasal Levels of Antimicrobial Peptides in Allergic Asthma Patients and Healthy Controls: Differences and Effect of a Short 1,25(OH)₂ Vitamin D3 Treatment

<div><p>Background</p><p>Allergy is often accompanied by infections and lower levels of antimicrobial peptides (AMPs). Vitamin D has been shown to increase expression of selected AMPs. In this study we investigated whether antimicrobial peptide levels in nasal secretions of allergic asthma patients are lower than in healthy controls, and whether administration of the active form of vitamin D (1,25(OH)₂D3) affects these antimicrobial peptide levels.</p><p>Methods</p><p>The levels of antimicrobial peptides in nasal secretions were compared between 19 allergic asthma patients and 23 healthy controls. The effect of seven days daily oral treatment with 2 μg 1,25(OH)₂D3 on antimicrobial peptides in nasal secretions was assessed in a placebo-controlled cross-over clinical study.</p><p>Results</p><p>Levels of neutrophil α-defensins (human neutrophil peptides 1–3; HNP1-3) and lipocalin 2 (LCN2; also known as NGAL) were significantly lower in asthmatics, but no differences in LL-37 and SLPI were detected. Treatment with a short-term 1,25(OH)₂D3 caused a small increase in HNP1-3, but not when the asthma and control groups were analyzed separately. LL-37, LCN2 and SLPI did not change after treatment with 1,25(OH)₂D3.</p><p>Conclusion</p><p>Levels of the antimicrobial peptides HNP1-3 and LCN2 are lower in nasal secretions in asthmatics and are not substantially affected by a short-term treatment with active vitamin D.</p></div

Effect of 1,25(OH)₂D3 treatment on levels of AMPs in nasal secretions.

<p>Change in levels of HNP1-3, LL-37, LCN2 and SLPI in nasal secretions from asthma patients and controls during placebo or 1,25(OH)₂D3 treatment. The horizontal bars represent the median AMP level before and after treatment.</p

Clinical characteristics of the study population according to asthma status.

<p>BMI: Body mass index; IQR: Interquartile range; SD standard deviation, NA: not applicable; FEV₁: percent predicted of FEV₁, ppb parts per billion p-values for differences between groups</p><p>Clinical characteristics of the study population according to asthma status.</p

Baseline AMPs, in nasal secretions.

<p>HNP1-3, LL-37, LCN2 and SLPI in nasal secretions from atopic asthma patients and healthy controls.</p

Single-blind, placebo-controlled cross-over design of the present study.

<p>Single-blind, placebo-controlled cross-over design of the present study.</p