Porta N, San Juan J, Grasa M P, Simal E, Ara M, Querol M Ara e I
Servicio de Dermatología. Hospital Universitario Miguel Servet. Zaragoza. España.
Actas Dermosifiliogr. 2008 Apr;99(3):207-12.
Skin diseases account for a high proportion of presenting complaints in primary health care. In Spain, the growing demand for consultations and the resulting longer waiting lists make it necessary to establish criteria for appropriate referrals to a specialist. This study aimed to investigate the characteristics of referrals from primary care centers to dermatology specialists as well as the correlation between the presenting complaint and the final dermatologic diagnosis.
We collected data from 3164 patients seen for the first time by dermatologists in our specialist service during 1998. Patients were stratified according to the referring primary health care center and the reason for referral. The agreement between the presenting complaint and the final dermatologic diagnosis was studied. For each dermatologic condition, the positive predictive value, diagnostic sensitivity, and k statistic were calculated.
The overall diagnostic agreement was 65.52 %. Primary care physicians were found to over diagnose diseases caused by papillomavirus and the diagnostic sensitivity was very low for diseases such as basal cell carcinoma and seborrheic keratosis.
It is necessary to insist on training primary care physicians, ensuring appropriate referral from primary health care clinics, and promoting an effective dialogue with the specialist.
在初级卫生保健中，皮肤病在就诊主诉中占比很高。在西班牙，对会诊的需求不断增加，导致候诊名单越来越长，因此有必要制定适当转诊至专科医生的标准。本研究旨在调查初级保健中心转诊至皮肤科专科医生的患者特征，以及就诊主诉与最终皮肤科诊断之间的相关性。
我们收集了1998年在我们专科服务中首次就诊的3164名患者的数据。患者根据转诊的初级卫生保健中心和转诊原因进行分层。研究了就诊主诉与最终皮肤科诊断之间的一致性。对于每种皮肤病，计算了阳性预测值、诊断敏感性和k统计量。
总体诊断一致性为65.52%。发现初级保健医生对乳头瘤病毒引起的疾病存在过度诊断，而对于基底细胞癌和脂溢性角化病等疾病，诊断敏感性非常低。
有必要坚持对初级保健医生进行培训，确保初级卫生保健诊所进行适当转诊，并促进与专科医生进行有效的沟通。
