de São José B P, Camargos P A M, Bateman E D, Botelho C M A, de Seixas Maciel J G F, Mancuzo E V, de Amorim Corrêa R
Post Graduate Programme on Infectious Diseases and Tropical Medicine, Federal University of Minas Gerais School of Medicine, Belo Horizonte, Minas Gerais, Brazil.
Paediatric Pulmonology Unit, University Hospital, Federal University of Minas Gerais School of Medicine, Belo Horizonte, Minas Gerais, Brazil.
Int J Tuberc Lung Dis. 2016 Oct;20(10):1392-1398. doi: 10.5588/ijtld.16.0294.
There are few reports on the ability of primary care physicians (PCPs) to diagnose acute and chronic respiratory diseases. We assessed the agreement between PCPs and pulmonologists in diagnosing pulmonary tuberculosis (TB), chronic obstructive pulmonary disease (COPD), asthma and acute respiratory infections (ARI).
Metropolitan Region of Belo Horizonte, State of Minas Gerais, Brazil.
PCPs filled out a symptom-based questionnaire for adult patients presenting with respiratory symptoms. Their diagnoses were compared to those of three pulmonologists who reviewed the data independently without seeing the patients. Agreement between PCP decisions and those of the pulmonologists was assessed.
Among a total of 554 patients, 60 PCPs correctly diagnosed 42.4% as having ARI, 17.3% asthma, 15.7% COPD and 12.4% suspected TB. Agreement between the PCPs and the pulmonologists was as follows: 0.53 for asthma (95%CI 0.45-0.60), 0.53 (95%CI 0.46-0.60) for ARI, 0.45 (95%CI 0.34-0.57) for TB and 0.40 (95%CI 0.29-0.50) for COPD.
Only reasonable to moderate agreement was found between PCPs and pulmonologists in diagnosing the most prevalent respiratory conditions. This result emphasises the need to adopt measures and provide tools to improve the diagnostic skills of PCPs for patients presenting with respiratory symptoms.
关于基层医疗医生（PCP）诊断急慢性呼吸道疾病能力的报道较少。我们评估了基层医疗医生与肺科医生在诊断肺结核（TB）、慢性阻塞性肺疾病（COPD）、哮喘和急性呼吸道感染（ARI）方面的一致性。
巴西米纳斯吉拉斯州贝洛奥里藏特大都市区。
基层医疗医生为有呼吸道症状的成年患者填写一份基于症状的问卷。将他们的诊断与三位独立审查数据且未见过患者的肺科医生的诊断进行比较。评估基层医疗医生的诊断决定与肺科医生诊断决定之间的一致性。
在总共554名患者中，60名基层医疗医生正确诊断出42.4%的患者患有ARI，17.3%患有哮喘，15.7%患有COPD，12.4%疑似患有TB。基层医疗医生与肺科医生之间的一致性如下：哮喘为0.53（95%CI 0.45 - 0.60），ARI为0.53（95%CI 0.46 - 0.60），TB为0.45（95%CI 0.34 - 0.57），COPD为0.40（95%CI 0.29 - 0.50）。
在诊断最常见的呼吸道疾病方面，基层医疗医生与肺科医生之间仅发现了合理到中等程度的一致性。这一结果强调了采取措施并提供工具以提高基层医疗医生对有呼吸道症状患者诊断技能的必要性。
