The influence of pulse oximetry on decision-making in general practice.

Background:

Lately pulse oximetry has become one of the standard diagnostic tools used in primary care. Despite this rapid development, it is still unknown in what way the use of pulse oximetry influences the decisions made by general practioners upon patient management, including prescription of medication, change in current doses of medication, use of oxygen and referral to the hospital. The aim of this empirical research is to provide a clear insight in the role of pulse oximetry in the management of patients with dyspnoea in general practice.



Methods:

A cluster randomized trial based on 10 standardized written case descriptions, executed in a crossover design with 55 general practitioners in the Netherlands. The general practitioners are asked to assess the patient cases twice, with an interval of at least 5 weeks. The cases are presented to them using an online survey. Depending on randomization, the SaO2 value will be visible during the first or the second measurement. For every case, general practitioners have to answer questions about their decisions regarding choice of treatment, including prescription of medication, change in current doses of medication, use of oxygen and referral to the hospital. They are also asked to report their level of confidence about the decisions they made.



Conclusion:

This study will provide new evidence on the influence of pulse oximetry on decision-making by general practitioners concerning their management of patients with dyspnea.

Pulse oximetry is a non-invasive method allowing monitoring of the oxygen saturation of a patient. For many years now, it has been used in secondary care with great success. Recently, it is noticed that pulse oximetry is used more often in the general practitioner’s office. General practitioners are quite satisfied with the use of pulse oximetry and most often they use it to support their decisions in the management of dyspnoeic patients. Though, the exact consequences of the use of pulse oximetry in primary care for patients and society are still unknown. Do general practitioners change their management, including the prescription of drugs, use of oxygen and referral to a hospital, when they use pulse oximetry? The current literature doesn’t provide an evidence based answer to these questions. That’s why the aim of this empirical research is to provide a clear insight of the role of pulse oximetry in patient management in general practice.

The first round of assessments of the set of case descriptions by the GPs is followed by a second round of assessments of the same case descriptions at least 5 weeks later.

In the intervention condition the study subjects (i.e., general practitioners) are provided with pulse oximetry results (SaO2) when assessing 10 standardised written case descriptions of patients with dyspneu. In the control condition, the general practitioners assess the same case description without having information about the SaO2.