Diagnostic accuracy of primary care asthma/COPD working hypotheses, a real life study

作者：Lucas Annelies E^*; Smeenk Frank J; Smeele Ivo J; van Schayck Onno P

来源：Respiratory Medicine, 2012, 106(8): 1158-1163.

DOI：10.1016/j.rmed.2012.03.002

• Asthma
• COPD
• Diagnosis
• Primary care

Misdiagnoses are inevitable when working hypotheses of asthma/COPD of General Practitioners (GPs) are not checked by spirometry. To reduce misdiagnoses, Asthma/COPD-support services (AC-services) offer support by performing spirometry assessed together with written medical history by consulting pulmonologists. %26lt;br%26gt;Research questions: Which criteria do GPs use to justify their asthma/COPD working hypotheses? How do diagnostic assessments by an AC-service change GPs%26apos; working hypotheses? Do GPs%26apos; justifications for their working hypotheses influence the extent to which working hypotheses correspond with diagnoses given by an AC-service? %26lt;br%26gt;Method: We investigated the working hypotheses of 17 GPs for 284 patients with respiratory problems and their justifications: %26quot;clinical symptoms%26quot;, %26quot;office spirometry%26quot;, or %26quot;specialist%26apos;s correspondence%26quot;. Working hypotheses were compared with diagnoses given by an AC-service, and the influence of the different justifications categories on diagnostic accuracy of the working hypotheses was described. %26lt;br%26gt;Results: 49% of the working hypothesis were only based on clinical information, 21% were also based on office spirometry. For 30% additional specialist information was available. 50% of the working hypotheses were confirmed by the AC-service. The working hypothesis asthma was confirmed more frequently (62%) than the working hypothesis COPD (40%). The justifications for the working hypotheses given by GPs did not influence these results. %26lt;br%26gt;Conclusion: Diagnostic assessments of the AC-service differed significantly from the working hypotheses of GPs, even when these were based on previous specialists%26apos; correspondence or on office spirometry. To optimize the diagnoses in primary care, diagnostic support of an AC-service is recommended for all primary care patients with respiratory problems.

• 出版日期2012-8