title: Diagnostic assessments of spirometry and medical history data by respiratory specialists supporting primary care: are they reliable?
abstract: 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.
authors.affiliation: Department of General Practice, Research Institute Caphri, Maastricht University, Maastricht, The Netherlands.
authors.forename: Annelies E M
authors.initials: AE
authors.lastname: Lucas
authors.forename: Frank J W M
authors.initials: FJ
authors.lastname: Smeenk
authors.forename: Ben E E M
authors.initials: BE
authors.lastname: van den Borne
authors.forename: Ivo J M
authors.initials: IJ
authors.lastname: Smeele
authors.forename: C P Onno
authors.initials: CP
authors.lastname: van Schayck
mesh_terms: 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