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[Diagnostic consistency between primary care physicians and rheumatologists]
M Sánchez Mollá1, J Tovar, M A Medina
1Hospital y Centro de Especialidades, Elche.
Objective:
To assess the concordance between the diagnoses on referral from Primary Care to the Rheumatology Clinic and the final diagnoses made by the Rheumatologist.
Design:
Crossover study.
Setting:
Rheumatology clinic in a specialist centre.
Patients:
The study covered the first 308 patients referred consecutively from Primary Care by Family or General practitioners after the opening of the clinic in 1989.
Intervention:
A form for referring the patient to the Rheumatologist and filling in the basic data was composed. The referring doctor was also asked to classify the patient in one of five possible diagnostic categories. These diagnoses were compared with the opinion of the Rheumatologist.
Measurements And Results:
The Family Doctor referred 105 patients and the General Practitioner, 203. The concordance between diagnoses as measured by the Kappa index was 0.61 (C.I. 0.81-0.41) for Family Doctors and 0.38 (C.I. 0.23-0.53) for General Practitioners.
Conclusions:
The concordance of diagnoses between Family Doctors and Rheumatologists is good, whereas it was only regular/moderate for General Practitioners, which seems to indicate a superior objective training of Family Doctors in the diagnosis of these patients.