São José Bruno Piassi, Bateman Eric, Botelho Cláudia Myriam Amaral, de Seixas Maciel José Geraldo Félix, Mancuzo Eliane Viana, Camargos Paulo A M, Corrêa Ricardo Amorim
Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil.
Post Graduate Program on Infectious Diseases and Tropical Medicine, Belo Horizonte, Brazil.
J Thorac Dis. 2022 Jul;14(7):2689-2697. doi: 10.21037/jtd-21-1345.
To evaluate the impact of training primary care physicians (PCPs) in the use of the practical approach lung health-global alliance against chronic respiratory diseases (PAL-GARD) upon their diagnostic skills.
In this real-life three-phase study, PCPs were allocated to a PAL-GARD training or control group. Patients who sought a primary care health facility due to cough, dyspnea and/or wheezing were eligible. The clinical diagnoses made by PCPs during the baseline and post-intervention phase were audited by a panel of pulmonologists. Kappa inter-rater statistics was used to compare agreement between PCPs and pulmonologists.
Thirty PCPs evaluated 536 patients, 358 in the intervention and 178 in the control group. According to Kappa, there was an increase in the agreement in the diagnosis of asthma (from 0.546 to 0.638), tuberculosis (from 0.393 to 0.655) and acute respiratory infections (ARI) (from 0.577 to 0.584) was observed in the PAL-GARD group, but there was a reduction in chronic obstructive pulmonary disease (COPD) (from 0.430 to 0.284).
In this setting, PAL-GARD-based guide and training improved the clinical diagnosis of common respiratory diseases with the exception of COPD.
评估培训基层医疗医生（PCP）使用实用方法肺部健康 - 全球抗击慢性呼吸道疾病联盟（PAL - GARD）对其诊断技能的影响。
在这项真实的三阶段研究中，将基层医疗医生分配到PAL - GARD培训组或对照组。因咳嗽、呼吸困难和/或喘息而寻求基层医疗保健机构的患者符合条件。由一组肺科医生审核基层医疗医生在基线期和干预后阶段做出的临床诊断。使用Kappa评分者间统计量来比较基层医疗医生和肺科医生之间的一致性。
30名基层医疗医生评估了536名患者，干预组358名，对照组178名。根据Kappa统计，在PAL - GARD组中，哮喘诊断的一致性有所提高（从0.546提高到0.638），肺结核（从0.393提高到0.655）和急性呼吸道感染（ARI）（从0.577提高到0.584），但慢性阻塞性肺疾病（COPD）的一致性有所降低（从0.430降低到0.284）。
在这种情况下，基于PAL - GARD的指南和培训除了COPD外，改善了常见呼吸道疾病的临床诊断。
