[Changes in patient profiles at a regional respiratory medicine clinic over a 10-year period]

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

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, pneumologist'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 was then compared between groups.

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 disorders 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 disorders (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.

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 increase 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.