University of Maastricht, Dept of Family Medicine, PO Box 616, 6200 MD Maastricht, Netherlands.
Respir Med. 2012 Aug;106(8):1158-63. doi: 10.1016/j.rmed.2012.03.002. Epub 2012 Jun 7.
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.
Which criteria do GPs use to justify their asthma/COPD working hypotheses? How do diagnostic assessments by an AC-service change GPs' working hypotheses? Do GPs' justifications for their working hypotheses influence the extent to which working hypotheses correspond with diagnoses given by an AC-service?
We investigated the working hypotheses of 17 GPs for 284 patients with respiratory problems and their justifications: "clinical symptoms", "office spirometry", or "specialist's correspondence". 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.
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.
Diagnostic assessments of the AC-service differed significantly from the working hypotheses of GPs, even when these were based on previous specialists' 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.
当全科医生（GP）的哮喘/COPD 工作假设未经肺量计检查时，误诊是不可避免的。为了减少误诊，哮喘/COPD 支持服务（AC 服务）通过由肺病专家进行的肺量计评估以及书面病史咨询来提供支持。
GP 用于证明其哮喘/COPD 工作假设的标准是什么？AC 服务的诊断评估如何改变 GP 的工作假设？GP 对其工作假设的理由是否会影响工作假设与 AC 服务给出的诊断之间的一致性程度？
我们调查了 17 名 GP 对 284 名有呼吸问题的患者的工作假设及其依据：“临床症状”、“办公肺量计”或“专家对应”。将工作假设与 AC 服务给出的诊断进行比较，并描述不同依据类别对工作假设诊断准确性的影响。
49%的工作假设仅基于临床信息，21%的工作假设还基于办公肺量计。对于 30%的患者，还提供了额外的专家信息。50%的工作假设得到了 AC 服务的确认。AC 服务确认的哮喘工作假设比 COPD 工作假设更频繁（62%比 40%）。GP 给出的工作假设的理由并未影响这些结果。
即使这些工作假设是基于之前的专家对应或办公肺量计，AC 服务的诊断评估与 GP 的工作假设也有很大差异。为了优化初级保健中的诊断，建议所有有呼吸问题的初级保健患者都接受 AC 服务的诊断支持。
