| Do family physicians' records fit guideline diagnosed COPD? | |
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MedLine Citation:
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PMID: 19228813 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Mieke Albers; Tjard Schermer; Johan Molema; Carien Kloek; Reinier Akkermans; Yvonne Heijdra; Chris van Weel |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2009-02-19 |
Journal Detail:
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Title: Family practice Volume: 26 ISSN: 1460-2229 ISO Abbreviation: Fam Pract Publication Date: 2009 Apr |
Date Detail:
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Created Date: 2009-03-16 Completed Date: 2009-06-25 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8500875 Medline TA: Fam Pract Country: England |
Other Details:
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Languages: eng Pagination: 81-7 Citation Subset: IM |
Affiliation:
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Department of Primary Care Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Asthma / diagnosis*, epidemiology Cross-Sectional Studies Diagnosis, Differential Early Diagnosis Family Practice / statistics & numerical data* Female Guideline Adherence / statistics & numerical data* Humans Male Mass Screening / statistics & numerical data Medical Records / statistics & numerical data* Middle Aged Netherlands Pulmonary Disease, Chronic Obstructive / diagnosis*, epidemiology Pulmonary Medicine / statistics & numerical data* Quality Assurance, Health Care Regression Analysis Respiratory Function Tests / statistics & numerical data Young Adult |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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