Educational examples 183 5 Target population Primary care smoking COPD patients Test • Annual spirometry • Purpose: Follow-up • Role in testmanagement pathway: Addon to history taking and physical examination Test result • FEV1 decrease ≥ 35 ml: positive • FEV1 decrease < 35 ml: negative • Failed test: inconclusive Including undesirable consequences (burden, side effects, societal costs) related to the test • Time for the patient • Costs • Dizziness Impact on people-important outcomes • TP: correct step-up in treatment reduced COPD deterioration drug side effects • FP: incorrect step-up in treatment unchanged risk of COPD deterioration drug side effects • TN: correct unchanged treatment, no impact on people important outcomes • FN: incorrect unchanged treatment deterioration of COPD Interpretation of test results and subsequent management • Positive: step-up in treatment • Negative: maintain treatment • Inconclusive: eventually repeat test or management determined by other clinical considerations Including undesirable consequences (burden, side effects, societal costs) related to management • Side effects of drug treatment (d).
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