The validity of diagnostic support of an asthma/COPD service in primary care.

Br J Gen Pract. 2007 Nov;57(544):892-896.
Lucas A, Smeenk F, Smeele I, Brouwer T, van Schayck O.
Primary Care Heath Care Centre 'Orion', Eindhoven, The Netherlands; Department of General Practice (HAG), Maastricht University, Maastricht, The Netherlands.

BACKGROUND: To support GPs in diagnosing and monitoring their patients with asthma/chronic obstructive pulmonary disease (COPD), 'asthma/COPD services' have been developed. Within these services, pulmonologists perform structured diagnostic and therapeutic assessments based on the combination of written history data and spirometry.

AIM: This study determines the validity of the diagnosis and advice when assessed using only written information.

DESIGN OF STUDY: The results of the diagnostic procedures of an asthma/COPD service were compared with the results of regular office consultations by pulmonologists.

SETTING: From January until August 2004, two pulmonologists examined 80 randomly selected patients referred to an asthma/COPD service in Eindhoven, the Netherlands.

METHOD: Concordance was analysed between diagnosis and advice based on written spirometry and history data, with assessments based on live consultations with the same patients by pulmonologists.

RESULTS: The validity of the assessed diagnosis was high (Cohen's kappa = 0.82). When the diagnosis was uncertain, the advice for medical treatment scored low in validity (Cohen's kappa = 0.39). The advice for additional diagnostic examinations had a high internal validity: in half of the patients, uncertainty in diagnosis turned into a definite diagnosis of asthma/COPD, or another cause for the complaints of the patient was revealed; in the other half, the diagnosis of asthma/COPD could be rejected.

CONCLUSIONS: A structured asthma/COPD service offering diagnosis and diagnostic advice assessed from written spirometry and history data is a new and valid facility that can support the GP who faces the complicated diagnostic procedures in a progressive number of patients with asthma/COPD.

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