José Bruno Piassi de São, Camargos Paulo Augusto Moreira, Cruz Filho Álvaro Augusto Souza da, Corrêa Ricardo de Amorim
UFMG Pneumology Outpatient Clinic, Hospital das Clínicas, Federal University of Minas Gerais Medical School, Belo Horizonte, MG, Brazil.
Pediatric Department, UFMG Medical School, Belo Horizonte, MG, Brazil.
Rev Assoc Med Bras (1992). 2014 Nov-Dec;60(6):599-612. doi: 10.1590/1806-9282.60.06.021.
Respiratory diseases are responsible for about a fifth of all deaths worldwide and its prevalence reaches 15% of the world population. Primary health care (PHC) is the gateway to the health system, and is expected to resolve up to 85% of health problems in general. Moreover, little is known about the diagnostic ability of general practitioners (GPs) in relation to respiratory diseases in PHC. This review aims to evaluate the diagnostic ability of GPs working in PHC in relation to more prevalent respiratory diseases, such as acute respiratory infections (ARI), tuberculosis, asthma and chronic obstructive pulmonary disease (COPD). 3,913 articles were selected, totaling 30 after application of the inclusion and exclusion criteria. They demonstrated the lack of consistent evidence on the accuracy of diagnoses of respiratory diseases by general practitioners. In relation to asthma and COPD, studies have shown diagnostic errors leading to overdiagnosis or underdiagnosis depending on the methodology used. The lack of precision for the diagnosis of asthma varied from 54% underdiagnosis to 34% overdiagnosis, whereas for COPD this ranged from 81% for underdiagnosis to 86.1% for overdiagnosis. For ARI, it was found that the inclusion of a complementary test for diagnosis led to an improvement in diagnostic accuracy. Studies show a low level of knowledge about tuberculosis on the part of general practitioners. According to this review, PHC represented by the GP needs to improve its ability for the diagnosis and management of this group of patients constituting one of its main demands.
呼吸系统疾病导致全球约五分之一的死亡，其患病率达世界人口的15%。初级卫生保健是卫生系统的门户，总体上有望解决高达85%的健康问题。此外，对于初级卫生保健中全科医生对呼吸系统疾病的诊断能力了解甚少。本综述旨在评估在初级卫生保健机构工作的全科医生对更常见呼吸系统疾病的诊断能力，如急性呼吸道感染（ARI）、结核病、哮喘和慢性阻塞性肺疾病（COPD）。共筛选出3913篇文章，应用纳入和排除标准后总计30篇。这些文章表明，关于全科医生对呼吸系统疾病诊断准确性缺乏一致的证据。关于哮喘和慢性阻塞性肺疾病，研究表明，根据所使用的方法，诊断错误会导致过度诊断或诊断不足。哮喘诊断缺乏准确性的情况从漏诊54%到误诊34%不等，而慢性阻塞性肺疾病的这一范围从漏诊81%到误诊86.1%。对于急性呼吸道感染，发现采用辅助诊断测试可提高诊断准确性。研究表明全科医生对结核病的了解程度较低。根据本综述，以全科医生为代表的初级卫生保健需要提高对这类构成其主要需求之一的患者的诊断和管理能力。
