title: Reliability of the diagnosis of rheumatic conditions at the primary health care level.
abstract: OBJECTIVE
  To assess the reliability of the diagnosis given to rheumatic disease patients at the primary care level, the clinical records of 612 patients at the outpatient clinic of rheumatology of the main General Hospital in Alicante (Spain) were studied.
  
  
  METHODS
  The accuracy indices (sensitivity, specificity), the predictive values of tentative diagnosis made by the referring physicians and the degree of agreement (Kappa statistics) with the final diagnoses made by rheumatologists at the outpatient clinic of rheumatology were calculated.
  
  
  RESULTS
  There were differences in diagnosis agreement depending on the age of the referring doctor, with a greater degree of concordance among younger ones. More than 50% of the referral diagnoses were modified at the rheumatology outpatient clinic. In the most frequent diagnoses (inflammatory rheumatic diseases, osteoarthritis, soft tissue rheumatism) the level of concordance and the predictive values were low.
  
  
  CONCLUSIONS
  Our results highlight the need for upgrading courses in rheumatology for primary care physicians who have not been exposed to systematic training in rheumatology during their undergraduate studies. The epidemiological studies on rheumatic diseases based on primary care data should be interpreted with caution.
authors.affiliation: Department of Public Health, University of Alicante, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Bolumar
authors.forename: M T
authors.initials: MT
authors.lastname: Ruiz
authors.forename: I
authors.initials: I
authors.lastname: Hernandez
authors.forename: E
authors.initials: E
authors.lastname: Pascual
mesh_terms: D000328:Adult; D000367:Age Factors; D000554:Ambulatory Care Facilities; D006801:Humans; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D012017:Referral and Consultation; D015203:Reproducibility of Results; D012216:Rheumatic Diseases / Q000175:diagnosis*; D012680:Sensitivity and Specificity