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Diagnostic Agreement Between Primary Care Physicians and Dermatologists in the Health Area of a Referral Hospital
Estudio de Concordancia Diagnóstica en Dermatología Entre Atención Primaria y Especializada en el Área de Salud de un Hospital de Referencia
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"apellidos" => "Pujol" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219008702324?idApp=UINPBA000044" "url" => "/15782190/0000009900000003/v1_201304241428/S1578219008702324/v1_201304241428/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original articles</span>" "titulo" => "Diagnostic Agreement Between Primary Care Physicians and Dermatologists in the Health Area of a Referral Hospital" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "207" "paginaFinal" => "212" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "N. Porta, J. San Juan, M.P. Grasa, E. Simal, M. Ara, I. Querol" "autores" => array:6 [ 0 => array:4 [ "nombre" => "N." "apellidos" => "Porta" "email" => array:1 [ 0 => "nportaa@medynet.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "San Juan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] ] 2 => array:3 [ "nombre" => "M.P." "apellidos" => "Grasa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] ] ] 3 => array:3 [ "nombre" => "E." "apellidos" => "Simal" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 4 => array:3 [ "nombre" => "M." "apellidos" => "Ara" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 5 => array:3 [ "nombre" => "I." "apellidos" => "Querol" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Miguel Servet, Zaragoza, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Computer Consultant, Centro de Profesores y Recursos n.° 1, Zaragoza, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] 2 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Clínico Universitario de Zaragoza, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Correspondence: Avda. Gómez Laguna 16, 3° A, 50009 Zaragoza, Spain." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estudio de Concordancia Diagnóstica en Dermatología Entre Atención Primaria y Especializada en el Área de Salud de un Hospital de Referencia" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaAceptado" => "2007-06-19" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec84148" "palabras" => array:3 [ 0 => "diagnostic agreement" 1 => "dermatologic diagnosis" 2 => "primary health care" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec84147" "palabras" => array:3 [ 0 => "concordancia diagnóstica" 1 => "diagnóstico dermatológico" 2 => "Atención Primaria" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p class="elsevierStyleSimplePara elsevierViewall">Skin diseases account for a high proportion of presenting complaints in primary health care. In Spain, the growing demand for consultations and the resulting longer waiting lists make it necessary to establish criteria for appropriate referrals to a specialist. This study aimed to investigate the characteristics of referrals from primary care centers to dermatology specialists as well as the correlation between the presenting complaint and the final dermatologic diagnosis.</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">We collected data from 3164 patients seen for the first time by dermatologists in our specialist service during 1998. Patients were stratified according to the referring primary health care center and the reason for referral. The agreement between the presenting complaint and the final dermatologic diagnosis was studied. For each dermatologic condition, the positive predictive value, diagnostic sensitivity, and κ statistic were calculated.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">The overall diagnostic agreement was 65.52%. Primary care physicians were found to overdiagnose diseases caused by papillomavirus and the diagnostic sensitivity was very low for diseases such as basal cellcarcinoma and seborrheic keratosis.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">It is necessary to insist on training primary care physicians, ensuring appropriate referral from primary health care clinics, and promoting an effective dialogue with the specialist.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p class="elsevierStyleSimplePara elsevierViewall">Las enfermedades dermatológicas representan un porcentaje importante de los motivos de consulta en Atención Primaria. En nuestro ámbito la creciente demanda de consulta y la consecuente aparición de listas de espera hace necesario establecer algún tipo de criterio para una adecuada derivación. Pretendemos en este estudio describir las características de la derivación desde los centros de Atención Primaria a las consultas de Dermatología, así como la correlación existente entre el motivo de consulta y el diagnóstico dermatológico final.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p class="elsevierStyleSimplePara elsevierViewall">Se recogen los datos de 3.164 pacientes atendidos por primera vez en nuestras consultas de Dermatología, durante 1998, clasificándose según el centro de Atención Primaria de procedencia y el motivo de consulta. Se realiza un estudio de concordancia entre el motivo de consulta y el diagnóstico dermatológico final, averiguando para cada caso el valor predictivo positivo, la sensibilidad diagnóstica y el índice de concordancia kappa.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">La concordancia diagnóstica global ha sido del 65,52%. Se detecta por parte del médico de Atención Primaria un sobrediagnóstico de las enfermedades por papilomavirus y una sensibilidad diagnóstica muy baja en patologías como el carcinoma basocelular y las queratosis seborreicas.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Se hace necesario insistir en la formación de los médicos de Atención Primaria, en una adecuada derivación desde los centros de Atención Primaria y en potenciar un buen modelo de interconsulta con el especialista.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:26 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The epidemiology of cutaneous diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:1 [ 0 => "R.S. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 7 | 10 |
| 2024 October | 64 | 63 | 127 |
| 2024 September | 50 | 20 | 70 |
| 2024 August | 95 | 56 | 151 |
| 2024 July | 54 | 32 | 86 |
| 2024 June | 86 | 43 | 129 |
| 2024 May | 60 | 33 | 93 |
| 2024 April | 55 | 41 | 96 |
| 2024 March | 60 | 24 | 84 |
| 2024 February | 59 | 38 | 97 |
| 2024 January | 39 | 35 | 74 |
| 2023 December | 44 | 14 | 58 |
| 2023 November | 58 | 51 | 109 |
| 2023 October | 58 | 31 | 89 |
| 2023 September | 44 | 29 | 73 |
| 2023 August | 33 | 32 | 65 |
| 2023 July | 38 | 39 | 77 |
| 2023 June | 40 | 25 | 65 |
| 2023 May | 39 | 25 | 64 |
| 2023 April | 34 | 25 | 59 |
| 2023 March | 26 | 21 | 47 |
| 2023 February | 20 | 18 | 38 |
| 2023 January | 30 | 35 | 65 |
| 2022 December | 30 | 40 | 70 |
| 2022 November | 17 | 32 | 49 |
| 2022 October | 18 | 19 | 37 |
| 2022 September | 56 | 40 | 96 |
| 2022 August | 26 | 28 | 54 |
| 2022 July | 18 | 26 | 44 |
| 2022 June | 17 | 28 | 45 |
| 2022 May | 35 | 50 | 85 |
| 2022 April | 38 | 52 | 90 |
| 2022 March | 34 | 46 | 80 |
| 2022 February | 23 | 24 | 47 |
| 2022 January | 14 | 38 | 52 |
| 2021 December | 23 | 37 | 60 |
| 2021 November | 27 | 40 | 67 |
| 2021 October | 30 | 43 | 73 |
| 2021 September | 25 | 39 | 64 |
| 2021 August | 28 | 29 | 57 |
| 2021 July | 23 | 51 | 74 |
| 2021 June | 42 | 48 | 90 |
| 2021 May | 25 | 35 | 60 |
| 2021 April | 41 | 63 | 104 |
| 2021 March | 64 | 17 | 81 |
| 2021 February | 47 | 19 | 66 |
| 2021 January | 38 | 14 | 52 |
| 2020 December | 31 | 7 | 38 |
| 2020 November | 28 | 14 | 42 |
| 2020 October | 15 | 14 | 29 |
| 2020 September | 29 | 18 | 47 |
| 2020 August | 20 | 19 | 39 |
| 2020 July | 22 | 6 | 28 |
| 2020 June | 31 | 21 | 52 |
| 2020 May | 30 | 16 | 46 |
| 2020 April | 20 | 18 | 38 |
| 2020 March | 38 | 26 | 64 |
| 2020 February | 4 | 9 | 13 |
| 2020 January | 0 | 7 | 7 |
| 2019 December | 0 | 2 | 2 |
| 2019 November | 2 | 8 | 10 |
| 2019 October | 0 | 1 | 1 |
| 2019 September | 0 | 4 | 4 |
| 2019 August | 0 | 1 | 1 |
| 2019 July | 0 | 8 | 8 |
| 2019 June | 0 | 18 | 18 |
| 2019 May | 1 | 57 | 58 |
| 2019 April | 0 | 12 | 12 |
| 2019 March | 0 | 7 | 7 |
| 2019 February | 0 | 8 | 8 |
| 2019 January | 0 | 1 | 1 |
| 2018 December | 0 | 7 | 7 |
| 2018 March | 2 | 1 | 3 |
| 2018 February | 15 | 4 | 19 |
| 2018 January | 15 | 7 | 22 |
| 2017 December | 17 | 10 | 27 |
| 2017 November | 18 | 2 | 20 |
| 2017 October | 11 | 3 | 14 |
| 2017 September | 16 | 8 | 24 |
| 2017 August | 24 | 4 | 28 |
| 2017 July | 27 | 1 | 28 |
| 2017 June | 29 | 7 | 36 |
| 2017 May | 25 | 8 | 33 |
| 2017 April | 24 | 6 | 30 |
| 2017 March | 30 | 6 | 36 |
| 2017 February | 21 | 5 | 26 |
| 2017 January | 25 | 11 | 36 |
| 2016 December | 32 | 9 | 41 |
| 2016 November | 24 | 6 | 30 |
| 2016 October | 25 | 11 | 36 |
| 2016 September | 27 | 11 | 38 |
| 2016 August | 25 | 5 | 30 |
| 2016 July | 29 | 18 | 47 |
| 2016 June | 10 | 4 | 14 |
| 2016 May | 9 | 15 | 24 |
| 2016 April | 8 | 4 | 12 |
| 2016 March | 5 | 14 | 19 |
| 2016 February | 5 | 9 | 14 |
| 2016 January | 11 | 12 | 23 |
| 2015 December | 12 | 9 | 21 |
| 2015 November | 9 | 4 | 13 |
| 2015 October | 8 | 4 | 12 |
| 2015 September | 3 | 3 | 6 |
| 2015 August | 10 | 1 | 11 |
| 2015 July | 32 | 10 | 42 |
| 2015 June | 35 | 6 | 41 |
| 2015 May | 63 | 16 | 79 |
| 2015 April | 33 | 13 | 46 |
| 2015 March | 44 | 9 | 53 |
| 2015 February | 23 | 11 | 34 |
| 2015 January | 27 | 21 | 48 |
| 2014 December | 31 | 10 | 41 |
| 2014 November | 21 | 16 | 37 |
| 2014 October | 39 | 16 | 55 |
| 2014 September | 33 | 15 | 48 |
| 2014 August | 50 | 25 | 75 |
| 2014 July | 43 | 25 | 68 |
| 2014 June | 50 | 18 | 68 |
| 2014 May | 42 | 22 | 64 |
| 2014 April | 39 | 20 | 59 |
| 2014 March | 62 | 19 | 81 |
| 2014 February | 29 | 12 | 41 |
| 2014 January | 49 | 20 | 69 |
| 2013 December | 38 | 18 | 56 |
| 2013 November | 35 | 14 | 49 |
| 2013 October | 25 | 21 | 46 |
| 2013 September | 24 | 19 | 43 |
| 2013 August | 25 | 31 | 56 |
| 2013 July | 30 | 32 | 62 |
| 2013 June | 28 | 27 | 55 |
| 2013 May | 24 | 30 | 54 |
| 2013 April | 27 | 18 | 45 |
| 2013 March | 30 | 25 | 55 |
| 2013 February | 24 | 13 | 37 |
| 2013 January | 13 | 3 | 16 |
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