Do family physicians' records fit guideline diagnosed COPD?
BACKGROUND
In family practice, chronic obstructive pulmonary disease (COPD) is usually not diagnosed until clinically apparent and of moderately advanced severity.


OBJECTIVE
To analyse the diagnostic process from early development onwards and to assess the current state of underpresentation and underdiagnosis of COPD and asthma in primary care in the Netherlands.


METHODS
The population-based study sample consisted of formerly undiagnosed subjects (n = 532) from family practice. Family physicians' (FPs) chronic respiratory disease diagnoses (as recorded over 10 years in their patient records) were compared to a cross-sectional but extensive diagnostic assessment by a chest physician. Logistic regression modelling was used for a retrospective analysis on the relation between respiratory symptoms, practice visit rate and FPs' diagnosis of COPD.


RESULTS
After 10 years, the chest physician diagnosed 26% of subjects as COPD and 16% as (late-onset) asthma. Underpresentation of these patients in family practice was 46%, whereas underdiagnosis occurred in 37% of patients. A chest physician diagnosis of COPD was associated with the presence of chronic cough [odds ratio (OR) = 2.3, 95% confidence interval (CI) 1.1-4.6], a FP diagnosis of COPD with chronic phlegm (OR = 10.6, 95% CI 1.3-83.6). Repeated practice visits (OR = 1.8) and presence of wheeze and breathlessness (OR = 5.5) appeared to trigger the diagnostic process in family practice.


CONCLUSIONS
There is still considerable underpresentation and underdiagnosis of COPD in family practice. As FPs focus on presented symptoms and as detection increases with the frequency of practice visits, diagnostic guidelines should stress the importance of persistent cough and phlegm to support timely diagnosis of COPD in family practice.
Albers
Mieke
M
Department of Primary Care Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Schermer
Tjard
T
Molema
Johan
J
Kloek
Carien
C
Akkermans
Reinier
R
Heijdra
Yvonne
Y
van Weel
Chris
C
D000328:Adult; D000368:Aged; D001249:Asthma / Q000175:diagnosis* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008499:Medical Records / Q000706:statistics & numerical data*; D008875:Middle Aged; D009426:Netherlands; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000453:epidemiology; D015272:Pulmonary Medicine / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care; D012044:Regression Analysis; D012129:Respiratory Function Tests / Q000706:statistics & numerical data; D055815:Young Adult