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Changes in Patient Profiles at a Regional Respiratory Medicine Clinic Over a 10-Year Period
Concha Pellicer Císcar
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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
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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Espadaler, Juan Bautista Gáldiz, Joaquim Gea" "autores" => array:8 [ 0 => array:3 [ "preGrado" => "Dra." "nombre" => "Juana" "apellidos" => "Martínez-Llorens" ] 1 => array:2 [ "nombre" => "Carlos" "apellidos" => "Coronell" ] 2 => array:2 [ "nombre" => "Alba" "apellidos" => "Ramírez-Sarmiento" ] 3 => array:2 [ "nombre" => "Mauricio" "apellidos" => "Orozco-Levi" ] 4 => array:2 [ "nombre" => "Josep M." "apellidos" => "Espadaler" ] 5 => array:2 [ "nombre" => "Juan Bautista" "apellidos" => "Gáldiz" ] 6 => array:2 [ "nombre" => "Joaquim" "apellidos" => "Gea" ] 7 => array:1 [ "colaborador" => "on behalf of the ENIGMA COPD study group" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212906605776?idApp=UINPBA00003Z" "url" => "/15792129/0000004200000010/v1_201305150229/S1579212906605776/v1_201305150229/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Articles</span>" "titulo" => "Changes in Patient Profiles at a Regional Respiratory Medicine Clinic Over a 10-Year Period" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "516" "paginaFinal" => "521" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Concha Pellicer Císcar" "autores" => array:1 [ 0 => array:5 [ "preGrado" => "Dra." "nombre" => "Concha Pellicer" "apellidos" => "Císcar" "email" => array:1 [ 0 => "pellicer_con@gva.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Unidad de Neumología, Hospital Francesc de Borja, Gandía, Valencia, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence: Dra. C. Pellicer Císcar. Unidad de Neumología. Hospital Francesc de Borja. Pg. de les Germanies, 71. 46700 Gandía. Valencia. España" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2005-07-05" "fechaAceptado" => "2006-04-11" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec154191" "palabras" => array:3 [ 0 => "Patient profile" 1 => "Respiratory medicine health services needs and demand" 2 => "Respiratory medicine clinic" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec154192" "palabras" => array:3 [ 0 => "Perfil neumológico" 1 => "Demanda asistencial neumológica" 2 => "Consulta de neumología" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "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.</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">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 (<span class="elsevierStyleItalic">P</span><.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: <span class="elsevierStyleItalic">a</span>) an increase in hospital-referred cases with right heart disease (<span class="elsevierStyleItalic">P</span><.001; relative risk [RR], 7.3) and in cases of obstructive sleep apnea syndrome (OSAS) (<span class="elsevierStyleItalic">P</span><.001; RR, 24.3)-the most common diagnosis in group B-referred from primary care and other specialist services and <span class="elsevierStyleItalic">b</span>) an overall decrease in cases of tuberculosis (<span class="elsevierStyleItalic">P</span><.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 (<span class="elsevierStyleItalic">P</span><.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.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">The changes observed over the 10-year period analyzed were as follows: <span class="elsevierStyleItalic">a</span>) a decrease in referrals made by primary care centers and emergency departments and an in referrals from other sources; <span class="elsevierStyleItalic">b</span>) a significant increase in referrals for OSAS, which became the most common reason for consultation; <span class="elsevierStyleItalic">c</span>) an increase in referrals for right heart disease; and <span class="elsevierStyleItalic">d</span>) a decrease in tuberculosis cases.</p>" ] "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Analizar los cambios cuantitativos y cualitativos de la demanda asistencial generada en una consulta neumológica comarcal en los últimos 10 años.</p> <span class="elsevierStyleSectionTitle">Pacientes y métodos</span><p class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">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: <span class="elsevierStyleItalic">a</span>) 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 <span class="elsevierStyleItalic">b</span>) 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.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Los cambios observados en el período de 10 años analizado son los siguientes: <span class="elsevierStyleItalic">a</span>) pérdida de pacientes procedentes de atención primaria y urgencias, junto a aumento del resto de procedencias; <span class="elsevierStyleItalic">b</span>) importante aumento del SAOS, que pasa a ser la causa más frecuente de consulta; <span class="elsevierStyleItalic">c</span>) aumento de enfermedades cardiovasculares derechas, y <span class="elsevierStyleItalic">d</span>) disminución de la enfermedad tuberculosa.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La etiologiAa de la tuberculosis (traducción del artículo original “Die Aetiologie der Tuberculose”)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R Koch" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Bol de la UICT" "fecha" => "1981" "volumen" => "56" "paginaInicial" => "95" "paginaFinal" => "109" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chemotherapy for tuberculosis today" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "WW Stead" 1 => "AK Dun" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/arrd.1982.125.3P2.94" "Revista" => array:7 [ "tituloSerie" => "Am Rev Respir Dís" "fecha" => "1982" "volumen" => "125" "numero" => "Koch Centennial Suppl" "paginaInicial" => "94" "paginaFinal" => "101" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7041725" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The diagnosis and therapy of tuberculosis during the past 100 years" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "DA Mitchison" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.200411-1603OE" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2005" "volumen" => "171" "paginaInicial" => "699" "paginaFinal" => "706" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15709048" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J Sauret Valet" 1 => "El ocaso de la tisiología" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Cien años de neumología 1900–2000" "paginaInicial" => "83" "paginaFinal" => "100" "serieFecha" => "1998" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La consolidación de la neumología" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J Sauret Valet" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Cien años de neumología 1900–2000" "paginaInicial" => "101" "paginaFinal" => "120" "serieFecha" => "1998" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "The burden of lung disease. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 5 | 9 |
| 2024 October | 30 | 20 | 50 |
| 2024 September | 30 | 17 | 47 |
| 2024 August | 50 | 43 | 93 |
| 2024 July | 29 | 18 | 47 |
| 2024 June | 29 | 28 | 57 |
| 2024 May | 34 | 30 | 64 |
| 2024 April | 19 | 28 | 47 |
| 2024 March | 18 | 13 | 31 |
| 2024 February | 17 | 21 | 38 |
| 2023 March | 0 | 4 | 4 |
| 2023 February | 19 | 18 | 37 |
| 2023 January | 19 | 33 | 52 |
| 2022 December | 15 | 20 | 35 |
| 2022 November | 24 | 23 | 47 |
| 2022 October | 22 | 49 | 71 |
| 2022 September | 10 | 25 | 35 |
| 2022 August | 20 | 31 | 51 |
| 2022 July | 40 | 53 | 93 |
| 2022 June | 38 | 37 | 75 |
| 2022 May | 46 | 44 | 90 |
| 2022 April | 32 | 44 | 76 |
| 2022 March | 18 | 34 | 52 |
| 2022 February | 18 | 22 | 40 |
| 2022 January | 9 | 25 | 34 |
| 2021 December | 22 | 52 | 74 |
| 2021 November | 17 | 52 | 69 |
| 2021 October | 16 | 51 | 67 |
| 2021 September | 17 | 58 | 75 |
| 2021 August | 14 | 22 | 36 |
| 2021 July | 13 | 23 | 36 |
| 2021 June | 19 | 43 | 62 |
| 2021 May | 12 | 20 | 32 |
| 2021 April | 26 | 51 | 77 |
| 2021 March | 21 | 30 | 51 |
| 2021 February | 12 | 15 | 27 |
| 2021 January | 14 | 14 | 28 |
| 2020 December | 10 | 23 | 33 |
| 2020 November | 4 | 14 | 18 |
| 2020 October | 9 | 18 | 27 |
| 2020 September | 8 | 6 | 14 |
| 2020 August | 11 | 12 | 23 |
| 2020 July | 8 | 18 | 26 |
| 2020 June | 12 | 4 | 16 |
| 2020 May | 25 | 16 | 41 |
| 2020 April | 12 | 20 | 32 |
| 2020 March | 23 | 9 | 32 |
| 2020 February | 22 | 17 | 39 |
| 2020 January | 19 | 13 | 32 |
| 2019 December | 13 | 10 | 23 |
| 2019 November | 10 | 15 | 25 |
| 2019 October | 6 | 8 | 14 |
| 2019 September | 9 | 7 | 16 |
| 2019 August | 9 | 13 | 22 |
| 2019 July | 8 | 17 | 25 |
| 2019 June | 4 | 5 | 9 |
| 2019 May | 11 | 15 | 26 |
| 2019 April | 11 | 20 | 31 |
| 2019 March | 9 | 14 | 23 |
| 2019 February | 6 | 9 | 15 |
| 2019 January | 8 | 5 | 13 |
| 2018 December | 12 | 17 | 29 |
| 2018 November | 14 | 1 | 15 |
| 2018 October | 27 | 13 | 40 |
| 2018 September | 8 | 11 | 19 |
| 2018 August | 1 | 0 | 1 |
| 2018 May | 10 | 0 | 10 |
| 2018 April | 6 | 4 | 10 |
| 2018 March | 6 | 5 | 11 |
| 2018 February | 5 | 8 | 13 |
| 2018 January | 9 | 9 | 18 |
| 2017 December | 7 | 7 | 14 |
| 2017 November | 3 | 6 | 9 |
| 2017 October | 3 | 3 | 6 |
| 2017 September | 3 | 4 | 7 |
| 2017 August | 6 | 8 | 14 |
| 2017 July | 8 | 1 | 9 |
| 2017 June | 8 | 11 | 19 |
| 2017 May | 4 | 5 | 9 |
| 2017 April | 4 | 4 | 8 |
| 2017 March | 3 | 44 | 47 |
| 2017 February | 8 | 2 | 10 |
| 2017 January | 5 | 1 | 6 |
| 2016 December | 6 | 2 | 8 |
| 2016 November | 11 | 9 | 20 |
| 2016 October | 14 | 8 | 22 |
| 2016 September | 3 | 3 | 6 |
| 2016 August | 13 | 6 | 19 |
| 2016 July | 6 | 0 | 6 |
| 2016 May | 1 | 0 | 1 |
| 2016 March | 2 | 0 | 2 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 29 | 8 | 37 |
| 2015 September | 23 | 5 | 28 |
| 2015 August | 22 | 8 | 30 |
| 2015 July | 15 | 3 | 18 |
| 2015 June | 26 | 6 | 32 |
| 2015 May | 39 | 6 | 45 |
| 2015 April | 25 | 7 | 32 |
| 2015 March | 23 | 7 | 30 |
| 2015 February | 16 | 5 | 21 |
| 2015 January | 26 | 4 | 30 |
| 2014 December | 21 | 4 | 25 |
| 2014 November | 16 | 4 | 20 |
| 2014 October | 31 | 6 | 37 |
| 2014 September | 28 | 14 | 42 |
| 2014 August | 26 | 12 | 38 |
| 2014 July | 26 | 2 | 28 |
| 2014 June | 36 | 7 | 43 |
| 2014 May | 31 | 8 | 39 |
| 2014 April | 35 | 7 | 42 |
| 2014 March | 43 | 6 | 49 |
| 2014 February | 39 | 8 | 47 |
| 2014 January | 22 | 8 | 30 |
| 2013 December | 26 | 6 | 32 |
| 2013 November | 30 | 8 | 38 |
| 2013 October | 30 | 7 | 37 |
| 2013 September | 24 | 6 | 30 |
| 2013 August | 44 | 13 | 57 |
| 2013 July | 36 | 9 | 45 |
| 2013 June | 18 | 7 | 25 |
| 2013 May | 28 | 3 | 31 |
| 2013 April | 22 | 3 | 25 |
| 2013 March | 6 | 2 | 8 |
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