Back to Search
Start Over
Do family physicians' records fit guideline diagnosed COPD?
- Source :
- Family Practice, 26, 2, pp. 81-7, Family Practice, 26, 81-7
- Publication Year :
- 2009
-
Abstract
- Contains fulltext : 80862.pdf (Publisher’s version ) (Open Access) BACKGROUND: In family practice, chronic obstructive pulmonary disease (COPD) is usually not diagnosed until clinically apparent and of moderately advanced severity. OBJECTIVE: To analyse the diagnostic process from early development onwards and to assess the current state of underpresentation and underdiagnosis of COPD and asthma in primary care in the Netherlands. METHODS: The population-based study sample consisted of formerly undiagnosed subjects (n = 532) from family practice. Family physicians' (FPs) chronic respiratory disease diagnoses (as recorded over 10 years in their patient records) were compared to a cross-sectional but extensive diagnostic assessment by a chest physician. Logistic regression modelling was used for a retrospective analysis on the relation between respiratory symptoms, practice visit rate and FPs' diagnosis of COPD. RESULTS: After 10 years, the chest physician diagnosed 26% of subjects as COPD and 16% as (late-onset) asthma. Underpresentation of these patients in family practice was 46%, whereas underdiagnosis occurred in 37% of patients. A chest physician diagnosis of COPD was associated with the presence of chronic cough [odds ratio (OR) = 2.3, 95% confidence interval (CI) 1.1-4.6], a FP diagnosis of COPD with chronic phlegm (OR = 10.6, 95% CI 1.3-83.6). Repeated practice visits (OR = 1.8) and presence of wheeze and breathlessness (OR = 5.5) appeared to trigger the diagnostic process in family practice. CONCLUSIONS: There is still considerable underpresentation and underdiagnosis of COPD in family practice. As FPs focus on presented symptoms and as detection increases with the frequency of practice visits, diagnostic guidelines should stress the importance of persistent cough and phlegm to support timely diagnosis of COPD in family practice.
- Subjects :
- Adult
Male
Pediatrics
medicine.medical_specialty
Quality Assurance, Health Care
Cross-sectional study
Medical Records
Diagnosis, Differential
Pulmonary Disease, Chronic Obstructive
Young Adult
Wheeze
medicine
Pulmonary Medicine
Humans
Mass Screening
Asthma
Aged
Netherlands
COPD
business.industry
Medical record
Guideline
Odds ratio
Effective primary care and public health [NCEBP 7]
Middle Aged
medicine.disease
Respiratory Function Tests
respiratory tract diseases
Pathogenesis and modulation of inflammation [N4i 1]
Chronic cough
Cross-Sectional Studies
Early Diagnosis
Regression Analysis
Female
Guideline Adherence
medicine.symptom
business
Family Practice
Subjects
Details
- ISSN :
- 02632136
- Volume :
- 26
- Database :
- OpenAIRE
- Journal :
- Family Practice
- Accession number :
- edsair.doi.dedup.....59bc319fd32290eafa3deeb00e9437fc