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        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p class="elsevierStyleSimplePara elsevierViewall">Skin diseases account for a high proportion of presenting complaints in primary health care&#46; In Spain&#44; the growing demand for consultations and the resulting longer waiting lists make it necessary to establish criteria for appropriate referrals to a specialist&#46; 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&#46;</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&#46; Patients were stratified according to the referring primary health care center and the reason for referral&#46; The agreement between the presenting complaint and the final dermatologic diagnosis was studied&#46; For each dermatologic condition&#44; the positive predictive value&#44; diagnostic sensitivity&#44; and &#954; statistic were calculated&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">The overall diagnostic agreement was 65&#46;52&#37;&#46; 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&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">It is necessary to insist on training primary care physicians&#44; ensuring appropriate referral from primary health care clinics&#44; and promoting an effective dialogue with the specialist&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p class="elsevierStyleSimplePara elsevierViewall">Las enfermedades dermatol&#243;gicas representan un porcentaje importante de los motivos de consulta en Atenci&#243;n Primaria&#46; En nuestro &#225;mbito la creciente demanda de consulta y la consecuente aparici&#243;n de listas de espera hace necesario establecer alg&#250;n tipo de criterio para una adecuada derivaci&#243;n&#46; Pretendemos en este estudio describir las caracter&#237;sticas de la derivaci&#243;n desde los centros de Atenci&#243;n Primaria a las consultas de Dermatolog&#237;a&#44; as&#237; como la correlaci&#243;n existente entre el motivo de consulta y el diagn&#243;stico dermatol&#243;gico final&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Se recogen los datos de 3&#46;164 pacientes atendidos por primera vez en nuestras consultas de Dermatolog&#237;a&#44; durante 1998&#44; clasific&#225;ndose seg&#250;n el centro de Atenci&#243;n Primaria de procedencia y el motivo de consulta&#46; Se realiza un estudio de concordancia entre el motivo de consulta y el diagn&#243;stico dermatol&#243;gico final&#44; averiguando para cada caso el valor predictivo positivo&#44; la sensibilidad diagn&#243;stica y el &#237;ndice de concordancia kappa&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">La concordancia diagn&#243;stica global ha sido del 65&#44;52&#37;&#46; Se detecta por parte del m&#233;dico de Atenci&#243;n Primaria un sobrediagn&#243;stico de las enfermedades por papilomavirus y una sensibilidad diagn&#243;stica muy baja en patolog&#237;as como el carcinoma basocelular y las queratosis seborreicas&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Se hace necesario insistir en la formaci&#243;n de los m&#233;dicos de Atenci&#243;n Primaria&#44; en una adecuada derivaci&#243;n desde los centros de Atenci&#243;n Primaria y en potenciar un buen modelo de interconsulta con el especialista&#46;</p>"
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Vol. 99. Núm. 3.
Páginas 207-212 (abril 2008)
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Vol. 99. Núm. 3.
Páginas 207-212 (abril 2008)
Original articles
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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
Visitas
6398
N. Portaa,
Autor para correspondencia
nportaa@medynet.com

Correspondence: Avda. Gómez Laguna 16, 3° A, 50009 Zaragoza, Spain.
, J. San Juanb, M.P. Grasac, E. Simala, M. Araa, I. Querola
a Servicio de Dermatología, Hospital Universitario Miguel Servet, Zaragoza, Spain
b Computer Consultant, Centro de Profesores y Recursos n.° 1, Zaragoza, Spain
c Servicio de Dermatología, Hospital Clínico Universitario de Zaragoza, Spain
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Abstract
Introduction

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.

Patients and methods

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.

Results

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.

Conclusions

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.

Key words:
diagnostic agreement
dermatologic diagnosis
primary health care
Resumen
Introducción

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.

Material y métodos

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.

Resultados

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.

Conclusiones

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.

Palabras clave:
concordancia diagnóstica
diagnóstico dermatológico
Atención Primaria
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