United States physician office visits for asthma have increased since 1989, and most of these visits are to primary care physicians. The National Institutes of Health has published guidelines for asthma diagnosis and management, implementation of which is expected to result in improved care and reduced costs. Compliance with asthma guidelines has been suboptimal, especially with spirometry recommendations, and more so in primary care clinics than in specialist clinics. Noncompliance has largely been attributed to physician and patient factors. This paper describes an experience with navigation of health system barriers to implementation of spirometry encountered at three primary care clinics affiliated with an internal medicine residency program. Included are perspectives and priorities of key individuals, systems issues related to institutions, and technical issues pertaining to spirometers. Navigation of ACGME core competencies is discussed.
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