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        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">To analyze the quantitative and qualitative changes in demand for health care services at a regional respiratory medicine clinic over a 10-year period&#46;</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">During the years 1992&#8211;1993 &#40;group A&#41; and 2002&#8211;2003 &#40;Group B&#41;&#44; the following information was recorded for all new patients&#58; referring physician&#39;s initial diagnosis&#44; pneunologist&#39;s definitive diagnosis&#44; age&#44; sex&#44; and source of referral &#40;primary care clinic&#44; emergency department&#44; hospital admission&#44; other specialist services&#44; and other sources&#41;&#46; The recorded data were then compared between groups&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">Group A comprised 616 patients and group B 424&#46; Most subjects were men &#40;60&#37;&#41; aged 40 to 80 years &#40;71&#46;9&#37; of group A&#59; 75&#46;7&#37; of group B&#41;&#46; In both groups&#44; most referrals came from primary care&#46; The number of patients in group B who were referred by primary care and by emergency departments decreased in comparison with group A&#44; while referrals from all other sources increased &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41;&#46; Initial diagnosis of airway diseases and associated symptoms produced most of the demand for health care services &#40;group A&#44; 58&#37;&#59; group B&#44; 62&#46;2&#37;&#41;&#46; When the 2 groups were compared&#44; the following changes were observed in group B&#58; <span class="elsevierStyleItalic">a</span>&#41; an increase in hospital-referred cases with right heart disease &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;001&#59; relative risk &#91;RR&#93;&#44; 7&#46;3&#41; and in cases of obstructive sleep apnea syndrome &#40;OSAS&#41; &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;001&#59; RR&#44; 24&#46;3&#41;-the most common diagnosis in group B-referred from primary care and other specialist services and <span class="elsevierStyleItalic">b</span>&#41; an overall decrease in cases of tuberculosis &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;001&#59; RR&#44; 0&#46;3&#41; and in referrals made without a recorded initial diagnosis by primary care physicians&#46; When definitive diagnoses were analyzed&#44; the initial diagnosis was confirmed in a high percentage of patients with airway diseases &#40;group A&#44; 47&#46;2&#37;&#59; group B&#44; 53&#46;1&#37;&#41;&#46; An increase in cases with a definitive diagnosis of OSAS was observed in group B &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;001&#59; RR&#44; 18&#46;3&#41; compared to group A&#46; In addition&#44; a 2-fold increase was recorded for right heart disease and consultations for radiographic abnormalities&#46; The number of patients diagnosed with tuberculosis decreased&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">The changes observed over the 10-year period analyzed were as follows&#58; <span class="elsevierStyleItalic">a</span>&#41; a decrease in referrals made by primary care centers and emergency departments and an in referrals from other sources&#59; <span class="elsevierStyleItalic">b</span>&#41; a significant increase in referrals for OSAS&#44; which became the most common reason for consultation&#59; <span class="elsevierStyleItalic">c</span>&#41; an increase in referrals for right heart disease&#59; and <span class="elsevierStyleItalic">d</span>&#41; a decrease in tuberculosis cases&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Analizar los cambios cuantitativos y cualitativos de la demanda asistencial generada en una consulta neumol&#243;gica comarcal en los &#250;ltimos 10 a&#241;os&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Durante los per&#237;odos correspondientes a los a&#241;os 1992&#8211;1993 &#40;grupo A&#41; y 2002&#8211;2003 &#40;grupo B&#41;&#44; de todos los pacientes remitidos como primera visita se registraron los siguientes datos&#58; diagn&#243;stico del m&#233;dico que remit&#237;a al paciente &#40;DI&#41;&#44; diagn&#243;stico final del neum&#243;logo&#44; edad&#44; sexo y procedencia &#40;atenci&#243;n primaria&#44; urgencias&#44; hospitalizaci&#243;n&#44; otra especialidad y otra procedencia&#41;&#46; Se describen las variables y se comparan &#233;stas entre los grupos A y B&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">El grupo A const&#243; de 616 pacientes y el grupo B de 424&#44; con predominio de varones &#40;60&#37;&#41; y mayor demanda entre 40 y 80 a&#241;os &#40;grupo A&#58; 71&#44;9&#37;&#59; grupo B&#58; 75&#44;7&#37;&#41;&#46; Atenci&#243;n primaria remit&#237;a la mayor parte de los pacientes&#44; pero con una disminuci&#243;n de &#233;sta y de urgencias en el grupo B&#44; frente a un aumento del resto de procedencias &#40;p &#60; 0&#44;001&#41;&#46; En cuanto al perfil de los DI&#44; las enfermedades de la v&#237;a a&#233;rea y los s&#237;ntomas generaban la mayor demanda &#40;grupo A&#58; 58&#37;&#59; grupo B&#58; 62&#44;2&#37;&#41;&#44; pero al comparar ambos grupos&#44; en el B se observaron&#58; <span class="elsevierStyleItalic">a</span>&#41; un aumento de s&#237;ndrome de apneas obstructivas durante el sue&#241;o &#40;SAOS&#41; &#40;p &#60; 0&#44;001&#59; riesgo relativo &#91;RR&#93; &#61; 24&#44;3&#41;&#44; que proced&#237;a de atenci&#243;n primaria y otras especialidades y constitu&#237;a el diagn&#243;stico m&#225;s frecuente&#44; as&#237; como de enfermedad cardiovascular de origen derecho &#40;p &#60; 0&#44;001&#59; RR &#61; 7&#44;3&#41;&#44; procedente de hospitalizaci&#243;n&#44; y <span class="elsevierStyleItalic">b</span>&#41; una disminuci&#243;n de enfermedad tuberculosa &#40;p &#60; 0&#44;001&#59; RR &#61; 0&#44;3&#41;&#46; de diversas procedencias&#44; as&#237; como de los pacientes remitidos desde atenci&#243;n primaria sin que constara el motivo de consulta&#46; Por lo que se refiere al perfil de los diagn&#243;sticos finales&#44; se confirm&#243; el perfil del DI con una elevada frecuencia en las enfermedades de la v&#237;a a&#233;rea &#40;grupo A&#58; 47&#44;2&#37;&#59; grupo B&#58; 53&#44;1&#37;&#41;&#44; aumento de SAOS en el grupo B &#40;p &#60; 0&#44;001&#59; RR &#61; 18&#44;3&#41;&#59; adem&#225;s&#44; se duplicaron los casos de enfermedades cardiovasculares derechas y de consulta por alteraciones radiol&#243;gicas&#44; y disminuy&#243; la enfermedad tuberculosa&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Los cambios observados en el per&#237;odo de 10 a&#241;os analizado son los siguientes&#58; <span class="elsevierStyleItalic">a</span>&#41; p&#233;rdida de pacientes procedentes de atenci&#243;n primaria y urgencias&#44; junto a aumento del resto de procedencias&#59; <span class="elsevierStyleItalic">b</span>&#41; importante aumento del SAOS&#44; que pasa a ser la causa m&#225;s frecuente de consulta&#59; <span class="elsevierStyleItalic">c</span>&#41; aumento de enfermedades cardiovasculares derechas&#44; y <span class="elsevierStyleItalic">d</span>&#41; disminuci&#243;n de la enfermedad tuberculosa&#46;</p>"
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Vol. 42. Issue 10.
Pages 516-521 (October 2006)
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Vol. 42. Issue 10.
Pages 516-521 (October 2006)
Original Articles
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Changes in Patient Profiles at a Regional Respiratory Medicine Clinic Over a 10-Year Period
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Concha Pellicer Císcar
Corresponding author
pellicer_con@gva.es

Correspondence: Dra. C. Pellicer Císcar. Unidad de Neumología. Hospital Francesc de Borja. Pg. de les Germanies, 71. 46700 Gandía. Valencia. España
Unidad de Neumología, Hospital Francesc de Borja, Gandía, Valencia, Spain
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Objective

To analyze the quantitative and qualitative changes in demand for health care services at a regional respiratory medicine clinic over a 10-year period.

Patients and methods

During the years 1992–1993 (group A) and 2002–2003 (Group B), the following information was recorded for all new patients: referring physician's initial diagnosis, pneunologist's definitive diagnosis, age, sex, and source of referral (primary care clinic, emergency department, hospital admission, other specialist services, and other sources). The recorded data were then compared between groups.

Results

Group A comprised 616 patients and group B 424. Most subjects were men (60%) aged 40 to 80 years (71.9% of group A; 75.7% of group B). In both groups, most referrals came from primary care. The number of patients in group B who were referred by primary care and by emergency departments decreased in comparison with group A, while referrals from all other sources increased (P<.001). Initial diagnosis of airway diseases and associated symptoms produced most of the demand for health care services (group A, 58%; group B, 62.2%). When the 2 groups were compared, the following changes were observed in group B: a) an increase in hospital-referred cases with right heart disease (P<.001; relative risk [RR], 7.3) and in cases of obstructive sleep apnea syndrome (OSAS) (P<.001; RR, 24.3)-the most common diagnosis in group B-referred from primary care and other specialist services and b) an overall decrease in cases of tuberculosis (P<.001; RR, 0.3) and in referrals made without a recorded initial diagnosis by primary care physicians. When definitive diagnoses were analyzed, the initial diagnosis was confirmed in a high percentage of patients with airway diseases (group A, 47.2%; group B, 53.1%). An increase in cases with a definitive diagnosis of OSAS was observed in group B (P<.001; RR, 18.3) compared to group A. In addition, a 2-fold increase was recorded for right heart disease and consultations for radiographic abnormalities. The number of patients diagnosed with tuberculosis decreased.

Conclusions

The changes observed over the 10-year period analyzed were as follows: a) a decrease in referrals made by primary care centers and emergency departments and an in referrals from other sources; b) a significant increase in referrals for OSAS, which became the most common reason for consultation; c) an increase in referrals for right heart disease; and d) a decrease in tuberculosis cases.

Key words:
Patient profile
Respiratory medicine health services needs and demand
Respiratory medicine clinic
Objetivo

Analizar los cambios cuantitativos y cualitativos de la demanda asistencial generada en una consulta neumológica comarcal en los últimos 10 años.

Pacientes y métodos

Durante los períodos correspondientes a los años 1992–1993 (grupo A) y 2002–2003 (grupo B), de todos los pacientes remitidos como primera visita se registraron los siguientes datos: diagnóstico del médico que remitía al paciente (DI), diagnóstico final del neumólogo, edad, sexo y procedencia (atención primaria, urgencias, hospitalización, otra especialidad y otra procedencia). Se describen las variables y se comparan éstas entre los grupos A y B.

Resultados

El grupo A constó de 616 pacientes y el grupo B de 424, con predominio de varones (60%) y mayor demanda entre 40 y 80 años (grupo A: 71,9%; grupo B: 75,7%). Atención primaria remitía la mayor parte de los pacientes, pero con una disminución de ésta y de urgencias en el grupo B, frente a un aumento del resto de procedencias (p < 0,001). En cuanto al perfil de los DI, las enfermedades de la vía aérea y los síntomas generaban la mayor demanda (grupo A: 58%; grupo B: 62,2%), pero al comparar ambos grupos, en el B se observaron: a) un aumento de síndrome de apneas obstructivas durante el sueño (SAOS) (p < 0,001; riesgo relativo [RR] = 24,3), que procedía de atención primaria y otras especialidades y constituía el diagnóstico más frecuente, así como de enfermedad cardiovascular de origen derecho (p < 0,001; RR = 7,3), procedente de hospitalización, y b) una disminución de enfermedad tuberculosa (p < 0,001; RR = 0,3). de diversas procedencias, así como de los pacientes remitidos desde atención primaria sin que constara el motivo de consulta. Por lo que se refiere al perfil de los diagnósticos finales, se confirmó el perfil del DI con una elevada frecuencia en las enfermedades de la vía aérea (grupo A: 47,2%; grupo B: 53,1%), aumento de SAOS en el grupo B (p < 0,001; RR = 18,3); además, se duplicaron los casos de enfermedades cardiovasculares derechas y de consulta por alteraciones radiológicas, y disminuyó la enfermedad tuberculosa.

Conclusiones

Los cambios observados en el período de 10 años analizado son los siguientes: a) pérdida de pacientes procedentes de atención primaria y urgencias, junto a aumento del resto de procedencias; b) importante aumento del SAOS, que pasa a ser la causa más frecuente de consulta; c) aumento de enfermedades cardiovasculares derechas, y d) disminución de la enfermedad tuberculosa.

Palabras clave:
Perfil neumológico
Demanda asistencial neumológica
Consulta de neumología
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