Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain.
UGC-DCCU Bahía de Cádiz-La Janda, Cádiz, Spain.
Int J Chron Obstruct Pulmon Dis. 2019 Jun 6;14:1187-1194. doi: 10.2147/COPD.S199322. eCollection 2019.
Inaccurate diagnosis in COPD is a current problem with relevant consequences in terms of inefficient health care, which has not been thoroughly studied in primary care medicine. The aim of the present study was to evaluate the degree of inaccurate diagnosis in Primary Care in Spain and study the determinants associated with it. The Community Assessment of COPD Health Care (COACH) study is a national, observational, randomized, non-interventional, national clinical audit aimed at evaluating clinical practice for patients with COPD in primary care medicine in Spain. For the present analysis, a correct diagnosis was evaluated based on previous exposure and airway obstruction with and without the presence of symptoms. The association of patient-level and center-level variables with inaccurate diagnosis was studied using multivariate multilevel binomial logistic regression models. During the study 4,307 cases from 63 centers were audited. The rate of inaccurate diagnosis was 82.4% (inter-regional range from 76.8% to 90.2%). Patient-related interventions associated with inaccurate diagnosis were related to active smoking, lung function evaluation, and specific therapeutic interventions. Center-level variables related to the availability of certain complementary tests and different aspects of the resources available were also associated with an inaccurate diagnosis. The prevalence data for the inaccurate diagnosis of COPD in primary care medicine in Spain establishes a point of reference in the clinical management of COPD. The descriptors of the variables associated with this inaccurate diagnosis can be used to identify cases and centers in which inaccurate diagnosis is occurring considerably, thus allowing for improvement.
COPD 诊断不准确是当前存在的问题，会导致医疗保健效率低下，但这在初级保健医学中尚未得到深入研究。本研究旨在评估西班牙初级保健中不准确诊断的程度，并研究与之相关的决定因素。
COACH 研究（社区评估 COPD 保健）是一项全国性、观察性、随机、非干预性、全国性临床审计，旨在评估西班牙初级保健医学中 COPD 患者的临床实践。在本分析中，根据以前的暴露和气道阻塞情况，以及是否存在症状，评估了正确的诊断。使用多变量多层二项逻辑回归模型研究了患者水平和中心水平变量与不准确诊断的相关性。
在研究期间，对来自 63 个中心的 4307 例患者进行了审核。不准确诊断的比率为 82.4%（区域间范围为 76.8%至 90.2%）。与不准确诊断相关的患者相关干预措施与主动吸烟、肺功能评估和特定治疗干预有关。与某些补充测试的可用性和可用资源的不同方面相关的中心水平变量也与不准确诊断相关。
西班牙初级保健医学中 COPD 不准确诊断的流行数据为 COPD 的临床管理提供了一个参考点。与这种不准确诊断相关的变量描述符可用于识别发生不准确诊断的病例和中心，从而进行改进。
