Diagnostic assessments of spirometry and medical history data by respiratory specialists supporting primary care: are they reliable?
OBJECTIVE
To determine the intra- and inter-observer reliability of respiratory specialists' diagnostic assessments of spirometry and written medical history data obtained from primary care.


METHODS
Five respiratory specialists assessed spirometry data and the history of 156 patients randomly selected from referrals to an asthma/COPD-service. The inter-observer reliability was evaluated. After six months, all specialists repeated the assessments and the intraobserver reliability was evaluated.


RESULTS
The diagnostic assessments for all patients had reasonable intra- and inter-observer reliability, resulting in a Cohen's kappa (kappa) of 0.67 and 0.66 respectively. The intra-observer reliability for assessing the need for additional diagnostic examinations had an average kappa 0.56 for new patients and an average kappa 0.39 for follow-up examinations. The assessments of clinical stability in follow-up patients--on which therapeutic advice was based--were inconsistent.


CONCLUSIONS
GPs who are reluctant to perform or interpret spirometry themselves may be supported diagnostically by respiratory specialists in an asthma/COPD-service. The reliability of this advice varies. More appropriate criteria for assessing clinical stability in patients with asthma and COPD are necessary to improve the reliability of the therapeutic advice.
Lucas
Annelies E M
AE
Department of General Practice, Research Institute Caphri, Maastricht University, Maastricht, The Netherlands.
Smeenk
Frank J W M
FJ
van den Borne
Ben E E M
BE
Smeele
Ivo J M
IJ
van Schayck
C P Onno
CP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008499:Medical Records; D008875:Middle Aged; D015588:Observer Variation; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis*; D015272:Pulmonary Medicine; D012017:Referral and Consultation; D012720:Severity of Illness Index; D013147:Spirometry; D055815:Young Adult