Evaluation of the appropriateness of plain chest film in chronic diseases.
OBJECTIVE
To improve continuity of care and appropriateness of plain chest film orders in patients suffering from chronic diseases (hypertension, chronic obstructive pulmonary disease (COPD) and lung tuberculosis.


METHODS
Retrospective evaluation study using explicit and normative consensued criteria.


METHODS
Urban health center.


RESULTS
Compliance with the continuity criteria was 48%, 65% and 76% in three successive evaluations. Compliance with the appropriateness criteria was 52% and 62%. Orders from patients with COPD were responsible for most of the lack of compliance. Causes of non-compliance with the continuity criteria were attitude and organizational problems; with regard to appropriateness, the main cause was external to the Health Center.


CONCLUSIONS
(1) Difficulty in improving registers, reflecting a defect in the continuity of care. (2) Usefulness of evaluation in discovering the causes of the problems, in these cases an external one. (3) Difficulty of improvement when the cause of the problem is external to our own setting. (4) Partial effectiveness of continuing education measures because of professional changes in the Health Center.
Marquet i Palomer
R
R
Health Center, La Mina, Sant Adrià de Besós, Barcelona, Catalonia, Spain.
Davins i Miralles
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D003266:Continuity of Patient Care; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging*; D008168:Lung / Q000000981:diagnostic imaging*; D008173:Lung Diseases, Obstructive / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011785:Quality Assurance, Health Care; D011859:Radiography; D011872:Radiology Department, Hospital / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013030:Spain; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging*; D014600:Utilization Review / Q000458:organization & administration*