title: The validity of diagnostic support of an asthma/COPD service in primary care.
abstract: BACKGROUND
  To support GPs in diagnosing and monitoring their patients with asthma/chronic obstructive pulmonary disease (COPD), 'asthma/COPD services' have been developed. Within these services, pulmonologists perform structured diagnostic and therapeutic assessments based on the combination of written history data and spirometry.
  
  
  OBJECTIVE
  This study determines the validity of the diagnosis and advice when assessed using only written information.
  
  
  METHODS
  The results of the diagnostic procedures of an asthma/COPD service were compared with the results of regular office consultations by pulmonologists.
  
  
  METHODS
  From January until August 2004, two pulmonologists examined 80 randomly selected patients referred to an asthma/COPD service in Eindhoven, the Netherlands.
  
  
  METHODS
  Concordance was analysed between diagnosis and advice based on written spirometry and history data, with assessments based on live consultations with the same patients by pulmonologists.
  
  
  RESULTS
  The validity of the assessed diagnosis was high (Cohen's kappa = 0.82). When the diagnosis was uncertain, the advice for medical treatment scored low in validity (Cohen's kappa = 0.39). The advice for additional diagnostic examinations had a high internal validity: in half of the patients, uncertainty in diagnosis turned into a definite diagnosis of asthma/COPD, or another cause for the complaints of the patient was revealed; in the other half, the diagnosis of asthma/COPD could be rejected.
  
  
  CONCLUSIONS
  A structured asthma/COPD service offering diagnosis and diagnostic advice assessed from written spirometry and history data is a new and valid facility that can support the GP who faces the complicated diagnostic procedures in a progressive number of patients with asthma/COPD.
authors.affiliation: Primary Care Heath Care Centre 'Orion', Eindhoven, The Netherlands. Annelies.Lucas@Hag.unimaas.nl
authors.forename: Annelies
authors.initials: A
authors.lastname: Lucas
authors.forename: Frank
authors.initials: F
authors.lastname: Smeenk
authors.forename: Ivo
authors.initials: I
authors.lastname: Smeele
authors.forename: Tim
authors.initials: T
authors.lastname: Brouwer
authors.forename: Onno
authors.initials: O
authors.lastname: van Schayck
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000175:diagnosis*; D003142:Communication; D005194:Family Practice; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis*; D012017:Referral and Consultation; D012720:Severity of Illness Index; D013147:Spirometry