Improving pulmonary auscultation as a tool in the diagnosis of bronchial obstruction--results of an educational intervention.

OBJECTIVE

To study the effect of an educational intervention on general practitioners' (GPs') ability to diagnose bronchial obstruction after clinical examination.

DESIGN

Based on physical chest examination 11 GPs assessed the degree of bronchial obstruction by estimating the patient's predicted forced expiratory volume in one second (FEV1%). Half way in the study the GPs were taught new knowledge on associations between lung sounds and bronchial airflow. The agreements between estimated and measured FEV1% predicted before and after this educational intervention were compared.

SETTING

11 GPs in five health centres in northern Norway took part.

PATIENTS

351 adult patients were included in phase 1, and 341 in phase 2.

MAIN OUTCOME MEASURES

Estimated and measured FEV1% predicted were compared in subgroups of patients according to clinical findings in phase 1 and 2. The effect of the intervention on the doctors' weighting of various chest signs could thus be evaluated. Kappa agreement and correlation between estimated and measured FEV1% predicted in both phases were determined.

RESULTS

The agreement between estimated and measured FEV1% predicted increased from Kw (weighted Kappa) = 0.33 in phase 1 to Kw = 0.43 in phase 2 (95% confidence interval 0.35-0.52). The GPs laid more relevant emphasis on rhonchi in their estimates after the educational intervention, while too much weight was laid on uncertain chest findings in phase 2.

CONCLUSION

The study shows a potential for better use of physical chest examination in the diagnosis of bronchial obstruction.