Diagnostic accuracy of respiratory diseases in primary healthunits

Revista da Associação Médica Brasileira

Bruno Piassi De São José¹  Paulo Augusto Moreira Camargos¹  Álvaro Augusto Souza Da Cruz Filho¹  Ricardo De Amorim Corrêa¹ 

关键词: respiratory tract diseases;    primary health care;    diagnosis;    general practitioners;    review;    doenças respiratórias;    atenção primária à saúde;    diagnóstico;    médicos de atenção primária;    revisão;   

DOI  :  10.1590/1806-9282.60.06.021

来源: SciELO

【 摘 要 】

Respiratory diseases are responsible for about a fifth of all deaths worldwide andits prevalence reaches 15% of the world population. Primary health care (PHC) is thegateway to the health system, and is expected to resolve up to 85% of health problemsin general. Moreover, little is known about the diagnostic ability of generalpractitioners (GPs) in relation to respiratory diseases in PHC. This review aims toevaluate the diagnostic ability of GPs working in PHC in relation to more prevalentrespiratory diseases, such as acute respiratory infections (ARI), tuberculosis,asthma and chronic obstructive pulmonary disease (COPD). 3,913 articles wereselected, totaling 30 after application of the inclusion and exclusion criteria. Theydemonstrated the lack of consistent evidence on the accuracy of diagnoses ofrespiratory diseases by general practitioners. In relation to asthma and COPD,studies have shown diagnostic errors leading to overdiagnosis or underdiagnosisdepending on the methodology used. The lack of precision for the diagnosis of asthmavaried from 54% underdiagnosis to 34% overdiagnosis, whereas for COPD this rangedfrom 81% for underdiagnosis to 86.1% for overdiagnosis. For ARI, it was found thatthe inclusion of a complementary test for diagnosis led to an improvement indiagnostic accuracy. Studies show a low level of knowledge about tuberculosis on thepart of general practitioners. According to this review, PHC represented by the GPneeds to improve its ability for the diagnosis and management of this group ofpatients constituting one of its main demands.

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