Bolumar F, Ruiz M T, Hernandez I, Pascual E
Department of Public Health, University of Alicante, Spain.
J Rheumatol. 1994 Dec;21(12):2344-8.
To assess the reliability of the diagnosis given to rheumatic disease patients at the primary care level, the clinical records of 612 patients at the outpatient clinic of rheumatology of the main General Hospital in Alicante (Spain) were studied.
The accuracy indices (sensitivity, specificity), the predictive values of tentative diagnosis made by the referring physicians and the degree of agreement (Kappa statistics) with the final diagnoses made by rheumatologists at the outpatient clinic of rheumatology were calculated.
There were differences in diagnosis agreement depending on the age of the referring doctor, with a greater degree of concordance among younger ones. More than 50% of the referral diagnoses were modified at the rheumatology outpatient clinic. In the most frequent diagnoses (inflammatory rheumatic diseases, osteoarthritis, soft tissue rheumatism) the level of concordance and the predictive values were low.
Our results highlight the need for upgrading courses in rheumatology for primary care physicians who have not been exposed to systematic training in rheumatology during their undergraduate studies. The epidemiological studies on rheumatic diseases based on primary care data should be interpreted with caution.
为评估基层医疗水平下对风湿性疾病患者诊断的可靠性，研究了西班牙阿利坎特主要综合医院风湿病门诊612例患者的临床记录。
计算准确性指标（敏感性、特异性）、转诊医生做出的初步诊断的预测值以及与风湿病门诊风湿病专家做出的最终诊断的一致程度（卡帕统计量）。
诊断一致性因转诊医生年龄而异，年轻医生之间的一致性程度更高。超过50%的转诊诊断在风湿病门诊被修改。在最常见的诊断（炎性风湿性疾病、骨关节炎、软组织风湿病）中，一致性水平和预测值较低。
我们的结果凸显了为本科学习期间未接受过风湿病系统培训的基层医疗医生开展风湿病进修课程的必要性。基于基层医疗数据的风湿性疾病流行病学研究应谨慎解读。
