Diagnostic Agreement Among General Practitioners, Residents, and Senior Rheumatologists for Rheumatic Diseases.
| Autor: | Farias Teixeira ME; From the Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil., Bonjorno LP, Menezes PISO, Gigante SLG, Dib SM, Oliveira FR, Silva LM, Petean FC, Moraes DA, Luppino-Assad R, Oliveira R, Almeida SCL, Oliveira MC, Louzada-Junior P, Oliveira RDR |
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| Jazyk: | angličtina |
| Zdroj: | Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases [J Clin Rheumatol] 2022 Sep 01; Vol. 28 (6), pp. 293-299. Date of Electronic Publication: 2022 Jun 03. |
| DOI: | 10.1097/RHU.0000000000001854 |
| Abstrakt: | Objective: The aim of this study was to evaluate the concordance of the diagnoses made by senior rheumatologists and those made by residents in rheumatology and by general practitioners (GPs). Methods: In this cohort, 497 patients referred by GPs from August 1, 2018 to December 16, 2019 were evaluated first by a second-year resident in rheumatology. After clinical rounds, the diagnoses by senior rheumatologists were assumed as the criterion standard and defined the prevalence of the rheumatic diseases, divided into 5 groups: rheumatoid arthritis, spondyloarthritis, other connective tissue diseases and vasculitis, nonautoimmune rheumatic diseases, and nonrheumatic diseases. The follow-up ended on November 30, 2020. We calculated sensibility, specificity, positive predictive value, negative predictive value, and κ coefficient of the diagnosis by GPs and residents. Results: The diagnoses were changed for 58% of the referral letters. Diseases of low complexity, such as fibromyalgia and osteoarthritis, accounted for 50% of the diagnoses. Compared with senior rheumatologists, residents in rheumatology had κ > 0.6 for all the groups, whereas GPs had κ < 0.5, with the worst performance for nonautoimmune rheumatic disease (κ = -0.18) and nonrheumatic disease (κ = 0.15). In terms of level of complexity, 46% of the letters were inappropriate. Conclusions: We found a poor level of diagnostic agreement between GPs and the rheumatology team. General practitioners had difficulties diagnosing and treating rheumatic diseases, referring patients that should be treated in the primary level of health care. One year of training in rheumatology made residents' skills comparable to those of senior rheumatologists. Competing Interests: The authors declare no conflict of interest. (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.) |
| Databáze: | MEDLINE |
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