Fiabilidad del diagnóstico de la EPOC en atención primaria y neumología en España. Factores predictivos
Reliability of chronic obstructive pulmonary disease diagnosis by primary care physicians and pneumologists in Spain. Predictive factors
J. de Miguel Díeza, J.L. Izquierdo Alonsob,
, J. Molina Parísc, J.M. Rodríguez González-Moroa, P. de Lucas Ramosa, G. Gaspar Alonso-Vegad
a Servicio de Neumología. Hospital General Universitario Gregorio Marañón. Madrid. España
b Sección de Neumología. Hospital General Universitario de Guadalajara. Guadalajara. España
c Centro de Salud Francia. Área Sanitaria 9. Fuenlabrada. Madrid. España
d Servicio de Medicina Interna. Hospital Universitario de Getafe. Getafe. Madrid. España
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"apellidos" => "de Miguel Díez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "J.L." "apellidos" => "Izquierdo Alonso" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "Molina París" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "J.M." "apellidos" => "Rodríguez González-Moro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "P." 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España" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Medicina Interna. Hospital Universitario de Getafe. Getafe. Madrid. España" "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Correspondencia: Sección de Neumología. Hospital General Universitario de Guadalajara.Donantes de Sangre, s/n. 19002 Guadalajara. España" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Reliability of chronic obstructive pulmonary disease diagnosis by primary care physicians and pneumologists in Spain. Predictive factors" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2002-07-03" "fechaAceptado" => "2002-11-19" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec190352" "palabras" => array:4 [ 0 => "EPOC" 1 => "Diagnóstico" 2 => "Atención primaria" 3 => "Neumología" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec190351" "palabras" => array:3 [ 0 => "Chronic obstructive pulmonary disease" 1 => "Primary care" 2 => "Pneumology" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Los objetivos de este estudio fueron evaluar la metodología empleada para el diagnóstico de la enfermedad pulmonar obstructiva crónica (EPOC) en atención primaria y en neumología en España, y analizar los factores que determinan la realización de un diagnóstico correcto de esta enfermedad</p> <span class="elsevierStyleSectionTitle">Material Y Método</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se llevó a cabo un estudio observacional, descriptivo, transversal y multicéntrico. La selección de participantes se realizó mediante muestreo aleatorio estratificado por población regional entre médicos de familia y neumólogos</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">De los 898 sujetos reclutados, 568 (63,2%) tenían obstrucción al flujo aéreo, 92 (10,3%) no cumplían los criterios funcionales de EPOC y 238 (26,5%) carecían de una espirometría que permitiera confirmar el diagnóstico y establecer la gravedad del proceso. Por niveles de actuación, sólo el 29,3% de los pacientes en atención primaria fueron clasificados de forma correcta, frente al 84,8% en neumología. Del total de sujetos diagnosticados correctamente de EPOC, el 38,6% en atención primaria y el 10,2% en neumología fueron diagnosticados inicialmente por criterios clínicos radiológicos. La disponibilidad de la espirometría en atención primaria fue del 49,1% frente al 97,8% en el ámbito de la neumología (p < 0,001). Además, sólo el 29,9% de los centros en el primer nivel asistencial contaban con un técnico encargado de la realización del estudio, comparado con el 97,8% en atención especializada de neumología (p < 0,001). Los factores que determinaron el uso de la espirometría para realizar el diagnóstico de EPOC fueron el nivel de asistencia, la disponibilidad de la prueba en atención primaria, el lugar de residencia y la situación de incapacidad laboral temporal por la EPOC</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Hay un elevado porcentaje de pacientes con EPOC erróneamente diagnosticados, sobre todo en el ámbito de la atención primaria. Existen diferencias en la metodología diagnóstica según el nivel de asistencia de los pacientes. La disponibilidad de la espirometría es un factor importante a la hora de realizar un diagnóstico correcto de EPOC</p>" ] "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The aims of this study were to assess the methods used by primary care physicians and pneumologists to diagnose chronic obstructive pulmonary disease (COPD) in Spain, and to analyze the factors affecting correct diagnosis of the disease</p> <span class="elsevierStyleSectionTitle">Material And Method</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">This observational, descriptive, cross-sectional and multicenter study enrolled a stratified randomized sample from each Spanish region from the practices of primary care physicians and pneumologists</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Five hundred sixty-eight (63.2%) of the 898 subjects enrolled had airway obstruction, 92 (10.3%) did not fulfill functional criteria for COPD and 238 (26.5%) did not perform spirometric tests to confirm the diagnosis and establish severity of disease. Primary care physicians classified 29.3% of the patients correctly, whereas pneumologists diagnosed 84.8% correctly. Clinical and/or radiologic criteria were the basis for correct diagnosis in 38.6% of the cases managed by primary care physicians and 10.2% of those treated by pneumologists. Spirometry was available to 49.1% of the primary care physicians and 97.8% of the pneumologists' cases (p < 0.001). Moreover, only 29.9% of the primary care settings had a technician in charge of performing the study, in comparison with 97.8% of the specialized pneumology settings (p < 0.001). The use of spirometry in diagnosing COPD was related to level of patient care (primary or specialized), availability of the test in the primary care setting, place of residence and a patient's situation of temporary absence from work due to COPD</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Many COPD patients are incorrectly diagnosed, particularly in primary care. There are differences in diagnostic procedures at the different levels of patient care. The availability of spirometry is an important factor for correctly diagnosing COPD</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 5 | 8 |
| 2024 October | 44 | 23 | 67 |
| 2024 September | 41 | 17 | 58 |
| 2024 August | 74 | 41 | 115 |
| 2024 July | 41 | 29 | 70 |
| 2024 June | 61 | 30 | 91 |
| 2024 May | 64 | 43 | 107 |
| 2024 April | 39 | 33 | 72 |
| 2024 March | 65 | 33 | 98 |
| 2024 February | 30 | 24 | 54 |
| 2024 January | 0 | 4 | 4 |
| 2023 December | 0 | 1 | 1 |
| 2023 November | 0 | 3 | 3 |
| 2023 October | 0 | 12 | 12 |
| 2023 September | 0 | 11 | 11 |
| 2023 July | 0 | 1 | 1 |
| 2023 June | 0 | 1 | 1 |
| 2023 March | 5 | 7 | 12 |
| 2023 February | 30 | 21 | 51 |
| 2023 January | 37 | 38 | 75 |
| 2022 December | 31 | 42 | 73 |
| 2022 November | 46 | 32 | 78 |
| 2022 October | 42 | 35 | 77 |
| 2022 September | 36 | 34 | 70 |
| 2022 August | 27 | 40 | 67 |
| 2022 July | 45 | 49 | 94 |
| 2022 June | 45 | 53 | 98 |
| 2022 May | 60 | 47 | 107 |
| 2022 April | 65 | 44 | 109 |
| 2022 March | 52 | 42 | 94 |
| 2022 February | 37 | 23 | 60 |
| 2022 January | 40 | 37 | 77 |
| 2021 December | 19 | 42 | 61 |
| 2021 November | 26 | 50 | 76 |
| 2021 October | 35 | 61 | 96 |
| 2021 September | 24 | 55 | 79 |
| 2021 August | 19 | 39 | 58 |
| 2021 July | 20 | 30 | 50 |
| 2021 June | 14 | 43 | 57 |
| 2021 May | 12 | 33 | 45 |
| 2021 April | 24 | 48 | 72 |
| 2021 March | 26 | 20 | 46 |
| 2021 February | 34 | 22 | 56 |
| 2021 January | 22 | 30 | 52 |
| 2020 December | 23 | 24 | 47 |
| 2020 November | 16 | 15 | 31 |
| 2020 October | 17 | 16 | 33 |
| 2020 September | 17 | 18 | 35 |
| 2020 August | 21 | 5 | 26 |
| 2020 July | 32 | 21 | 53 |
| 2020 June | 14 | 7 | 21 |
| 2020 May | 25 | 20 | 45 |
| 2020 April | 22 | 11 | 33 |
| 2020 March | 16 | 19 | 35 |
| 2020 February | 22 | 20 | 42 |
| 2020 January | 23 | 38 | 61 |
| 2019 December | 29 | 20 | 49 |
| 2019 November | 3 | 16 | 19 |
| 2019 October | 10 | 15 | 25 |
| 2019 September | 19 | 24 | 43 |
| 2019 August | 17 | 14 | 31 |
| 2019 July | 21 | 29 | 50 |
| 2019 June | 13 | 31 | 44 |
| 2019 May | 28 | 36 | 64 |
| 2019 April | 10 | 22 | 32 |
| 2019 March | 7 | 31 | 38 |
| 2019 February | 10 | 20 | 30 |
| 2019 January | 10 | 7 | 17 |
| 2018 December | 19 | 24 | 43 |
| 2018 November | 36 | 24 | 60 |
| 2018 October | 71 | 31 | 102 |
| 2018 September | 23 | 17 | 40 |
| 2018 May | 4 | 1 | 5 |
| 2018 April | 8 | 9 | 17 |
| 2018 March | 14 | 10 | 24 |
| 2018 February | 10 | 11 | 21 |
| 2018 January | 12 | 12 | 24 |
| 2017 December | 10 | 14 | 24 |
| 2017 November | 5 | 8 | 13 |
| 2017 October | 9 | 11 | 20 |
| 2017 September | 8 | 19 | 27 |
| 2017 August | 10 | 34 | 44 |
| 2017 July | 12 | 21 | 33 |
| 2017 June | 32 | 41 | 73 |
| 2017 May | 14 | 23 | 37 |
| 2017 April | 7 | 21 | 28 |
| 2017 March | 20 | 13 | 33 |
| 2017 February | 51 | 12 | 63 |
| 2017 January | 24 | 10 | 34 |
| 2016 December | 30 | 11 | 41 |
| 2016 November | 49 | 24 | 73 |
| 2016 October | 45 | 44 | 89 |
| 2016 September | 43 | 34 | 77 |
| 2016 August | 28 | 7 | 35 |
| 2016 July | 40 | 6 | 46 |
| 2016 June | 35 | 12 | 47 |
| 2016 May | 51 | 14 | 65 |
| 2016 April | 30 | 1 | 31 |
| 2016 March | 22 | 4 | 26 |
| 2016 February | 19 | 3 | 22 |
| 2016 January | 46 | 26 | 72 |
| 2015 December | 39 | 18 | 57 |
| 2015 November | 60 | 20 | 80 |
| 2015 October | 120 | 2 | 122 |
| 2015 September | 111 | 0 | 111 |
| 2015 August | 106 | 0 | 106 |
| 2015 July | 96 | 0 | 96 |
| 2015 June | 64 | 0 | 64 |
| 2015 May | 114 | 0 | 114 |
| 2015 April | 85 | 0 | 85 |
| 2015 March | 94 | 0 | 94 |
| 2015 February | 73 | 0 | 73 |
| 2015 January | 84 | 0 | 84 |
| 2014 December | 78 | 0 | 78 |
| 2014 November | 64 | 0 | 64 |
| 2014 October | 79 | 0 | 79 |
| 2014 September | 50 | 0 | 50 |
| 2014 August | 67 | 0 | 67 |
| 2014 July | 53 | 0 | 53 |
| 2014 June | 118 | 0 | 118 |
| 2014 May | 121 | 0 | 121 |
| 2014 April | 119 | 0 | 119 |
| 2014 March | 91 | 0 | 91 |
| 2014 February | 83 | 0 | 83 |
| 2014 January | 71 | 0 | 71 |
| 2013 December | 68 | 0 | 68 |
| 2013 November | 67 | 0 | 67 |
| 2013 October | 86 | 0 | 86 |
| 2013 September | 58 | 0 | 58 |
| 2013 August | 60 | 0 | 60 |
| 2013 July | 65 | 0 | 65 |
| 2013 June | 57 | 0 | 57 |
| 2013 May | 70 | 0 | 70 |
| 2013 April | 34 | 0 | 34 |
| 2013 March | 12 | 0 | 12 |
| 2000 January | 6129 | 0 | 6129 |
Show all
