Poels P J P, Schermer T R J, Schellekens D P A, Akkermans R P, de Vries Robbé P F, Kaplan A, Bottema B J A M, van Weel C
Dept of General Practice (117), Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
Eur Respir J. 2008 Jan;31(1):84-92. doi: 10.1183/09031936.00012007. Epub 2007 Jun 27.
The present study assessed the impact of computerised spirometry interpretation expert support on the diagnostic achievements of general practitioners (GPs), and on GPs' decision making in diagnosing chronic respiratory disease. A cluster-randomised controlled trial was performed in 78 GPs who each completed 10 standardised paper case descriptions. Intervention consisted of support for GPs' spirometry interpretation either by an expert system (expert support group) or by sham information (control group). Agreement of GPs' diagnoses was compared with an expert panel judgement, which served as the primary outcome. Secondary outcomes were: additional diagnostic test rates; width of differential diagnosis; certainty of diagnosis; estimated severity of disease; referral rate; and medication or nonmedication changes. Effects were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). There were no differences between the expert support and control groups in the agreement between GPs and expert panel diagnosis of chronic obstructive pulmonary disease (OR (95% CI) 1.08 (0.70-1.66)), asthma (1.13 (0.70-1.80)), and absence of respiratory disease (1.32 (0.61-2.86)). A higher rate of additional diagnostic tests was observed in the expert support group (2.5 (1.17-5.35)). Computerised spirometry expert support had no detectable benefit on general practitioners' diagnostic achievements and the decision-making process when diagnosing chronic respiratory disease.
本研究评估了计算机化肺功能测定解读专家支持对全科医生（GP）诊断结果以及对GP诊断慢性呼吸道疾病决策的影响。对78名GP进行了一项整群随机对照试验，每位GP均完成了10份标准化纸质病例描述。干预措施包括通过专家系统为GP的肺功能测定解读提供支持（专家支持组）或提供虚假信息（对照组）。将GP诊断的一致性与专家小组的判断进行比较，专家小组的判断作为主要结果。次要结果包括：额外诊断测试率；鉴别诊断范围；诊断确定性；估计疾病严重程度；转诊率；以及药物或非药物治疗的变化。效应以比值比（OR）及其95%置信区间（CI）表示。在GP与专家小组对慢性阻塞性肺疾病（OR（95%CI）1.08（0.70 - 1.66））、哮喘（1.13（0.70 - 1.80））和无呼吸道疾病（1.32（0.61 - 2.86））的诊断一致性方面，专家支持组和对照组之间没有差异。在专家支持组中观察到更高的额外诊断测试率（2.5（1.17 - 5.35））。在诊断慢性呼吸道疾病时，计算机化肺功能测定专家支持对全科医生的诊断结果和决策过程没有可检测到的益处。
