Family Practice Advance Access originally published online on February 19, 2009
Family Practice 2009 26(2):81-87; doi:10.1093/fampra/cmp005
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Do family physicians' records fit guideline diagnosed COPD?
a Department of Primary Care Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
b Radboud University Nijmegen Medical Centre, University Lung Centre Dekkerswald, Groesbeek, The Netherlands
c Department of Lung Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
Correspondence to Tjard Schermer, Department of Primary Care Medicine (117-HAG), Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands. Email: t.schermer{at}hag.umcn.nl
Received 27 November 2007; Revised 30 December 2008; Accepted 24 January 2009.
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Abstract |
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Background. In family practice, chronic obstructive pulmonary disease (COPD) is usually not diagnosed until clinically apparent and of moderately advanced severity.
Objective. To analyse the diagnostic process from early development onwards and to assess the current state of underpresentation and underdiagnosis of COPD and asthma in primary care in the Netherlands.
Methods. The population-based study sample consisted of formerly undiagnosed subjects (n = 532) from family practice. Family physicians’ (FPs) chronic respiratory disease diagnoses (as recorded over 10 years in their patient records) were compared to a cross-sectional but extensive diagnostic assessment by a chest physician. Logistic regression modelling was used for a retrospective analysis on the relation between respiratory symptoms, practice visit rate and FPs’ diagnosis of COPD.
Results. After 10 years, the chest physician diagnosed 26% of subjects as COPD and 16% as (late-onset) asthma. Underpresentation of these patients in family practice was 46%, whereas underdiagnosis occurred in 37% of patients. A chest physician diagnosis of COPD was associated with the presence of chronic cough [odds ratio (OR) = 2.3, 95% confidence interval (CI) 1.1–4.6], a FP diagnosis of COPD with chronic phlegm (OR = 10.6, 95% CI 1.3–83.6). Repeated practice visits (OR = 1.8) and presence of wheeze and breathlessness (OR = 5.5) appeared to trigger the diagnostic process in family practice.
Conclusions. There is still considerable underpresentation and underdiagnosis of COPD in family practice. As FPs focus on presented symptoms and as detection increases with the frequency of practice visits, diagnostic guidelines should stress the importance of persistent cough and phlegm to support timely diagnosis of COPD in family practice.
Keywords. Asthma, COPD, early diagnosis, family medicine, guideline.
Albers M, Schermer T, Molema J, Kloek C, Akkermans R, Heijdra Y and van Weel C. Do family physicians’ records fit guideline diagnosed COPD? Family Practice 2009; 26: 81–87.