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Chronic obstructive pulmonary disease in Brazilian primary care: Diagnostic competence and case-finding.
Hamers, Raph; Bontemps, Sander; van den Akker, Marjan; Souza, Ruy; Penaforte, Júlio; Chavannes, Niels.
Afiliação
  • Hamers R; Care and Public Health Research Institute, Department of General Practice, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands. rhamers@hotmail.com
Prim Care Respir J ; 15(5): 299-306, 2006 Oct.
Article em En | MEDLINE | ID: mdl-16978923
AIMS: The developing world is particularly at risk of an increasing health burden due to an increased prevalence of Chronic Obstructive Pulmonary Disease (COPD) secondary to increasing tobacco consumption. However, research is scarce. The objectives of this study were to assess the current competence for diagnosing COPD in primary care in a resource-limited setting in Brazil, and to develop a local patient profile for case-finding. METHODS: 34 general practitioners (GPs) in five areas of northern Brazil recruited adult patients with principal complaints of cough and/or shortness of breath who then had spirometry (n = 142). RESULTS: For the dichotomous variable 'COPD' the degree of agreement between GP diagnosis (n = 64, 18.3%) and spirometric outcome (n = 36, 25.4%) was poor, with Kappa = 0.055 (SE 0.087) and DOR = 1.35. False-positive and false-negative diagnosis proportions were 19.8% and 75%, respectively. Independent risk factors were 'smoking history of more than five pack years' and 'presence of both dyspnoea and cough'. It requires the testing of 2.2 smokers with more than five pack years to detect one patient at risk. CONCLUSIONS: COPD is a common yet underdiagnosed disease in Brazilian primary care. Spirometry improves diagnostic competence and case-finding substantially. If applied in a pre-selected high-risk population, we believe spirometry can be a cost-effective diagnostic tool for case-finding in the resource-limited setting. This study provides important baseline information for effective guideline implementation.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Competência Clínica / Doença Pulmonar Obstrutiva Crônica / Medicina de Família e Comunidade Tipo de estudo: Diagnostic_studies / Guideline / Prevalence_studies / Prognostic_studies / Risk_factors_studies Limite: Adolescent / Adult / Female / Humans / Male / Middle aged País/Região como assunto: America do sul / Brasil Idioma: En Revista: Prim Care Respir J Ano de publicação: 2006 Tipo de documento: Article País de afiliação: Holanda País de publicação: Reino Unido

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Competência Clínica / Doença Pulmonar Obstrutiva Crônica / Medicina de Família e Comunidade Tipo de estudo: Diagnostic_studies / Guideline / Prevalence_studies / Prognostic_studies / Risk_factors_studies Limite: Adolescent / Adult / Female / Humans / Male / Middle aged País/Região como assunto: America do sul / Brasil Idioma: En Revista: Prim Care Respir J Ano de publicação: 2006 Tipo de documento: Article País de afiliação: Holanda País de publicação: Reino Unido