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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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Salgado, A. Toll, B. Espinet, E. González-Roca, C.L. Barranco, S. Serrano, F. Solé, R.M. Pujol" "autores" => array:8 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Salgado" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Toll" ] 2 => array:2 [ "nombre" => "B." "apellidos" => "Espinet" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "González-Roca" ] 4 => array:2 [ "nombre" => "C.L." "apellidos" => "Barranco" ] 5 => array:2 [ "nombre" => "S." "apellidos" => "Serrano" ] 6 => array:2 [ "nombre" => "F." "apellidos" => "Solé" ] 7 => array:2 [ "nombre" => "R.M." "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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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 2 | 7 | 9 |
| 2024 Octubre | 64 | 63 | 127 |
| 2024 Septiembre | 50 | 20 | 70 |
| 2024 Agosto | 95 | 56 | 151 |
| 2024 Julio | 54 | 32 | 86 |
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| 2024 Marzo | 60 | 24 | 84 |
| 2024 Febrero | 59 | 38 | 97 |
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| 2023 Noviembre | 58 | 51 | 109 |
| 2023 Octubre | 58 | 31 | 89 |
| 2023 Septiembre | 44 | 29 | 73 |
| 2023 Agosto | 33 | 32 | 65 |
| 2023 Julio | 38 | 39 | 77 |
| 2023 Junio | 40 | 25 | 65 |
| 2023 Mayo | 39 | 25 | 64 |
| 2023 Abril | 34 | 25 | 59 |
| 2023 Marzo | 26 | 21 | 47 |
| 2023 Febrero | 20 | 18 | 38 |
| 2023 Enero | 30 | 35 | 65 |
| 2022 Diciembre | 30 | 40 | 70 |
| 2022 Noviembre | 17 | 32 | 49 |
| 2022 Octubre | 18 | 19 | 37 |
| 2022 Septiembre | 56 | 40 | 96 |
| 2022 Agosto | 26 | 28 | 54 |
| 2022 Julio | 18 | 26 | 44 |
| 2022 Junio | 17 | 28 | 45 |
| 2022 Mayo | 35 | 50 | 85 |
| 2022 Abril | 38 | 52 | 90 |
| 2022 Marzo | 34 | 46 | 80 |
| 2022 Febrero | 23 | 24 | 47 |
| 2022 Enero | 14 | 38 | 52 |
| 2021 Diciembre | 23 | 37 | 60 |
| 2021 Noviembre | 27 | 40 | 67 |
| 2021 Octubre | 30 | 43 | 73 |
| 2021 Septiembre | 25 | 39 | 64 |
| 2021 Agosto | 28 | 29 | 57 |
| 2021 Julio | 23 | 51 | 74 |
| 2021 Junio | 42 | 48 | 90 |
| 2021 Mayo | 25 | 35 | 60 |
| 2021 Abril | 41 | 63 | 104 |
| 2021 Marzo | 64 | 17 | 81 |
| 2021 Febrero | 47 | 19 | 66 |
| 2021 Enero | 38 | 14 | 52 |
| 2020 Diciembre | 31 | 7 | 38 |
| 2020 Noviembre | 28 | 14 | 42 |
| 2020 Octubre | 15 | 14 | 29 |
| 2020 Septiembre | 29 | 18 | 47 |
| 2020 Agosto | 20 | 19 | 39 |
| 2020 Julio | 22 | 6 | 28 |
| 2020 Junio | 31 | 21 | 52 |
| 2020 Mayo | 30 | 16 | 46 |
| 2020 Abril | 20 | 18 | 38 |
| 2020 Marzo | 38 | 26 | 64 |
| 2020 Febrero | 4 | 9 | 13 |
| 2020 Enero | 0 | 7 | 7 |
| 2019 Diciembre | 0 | 2 | 2 |
| 2019 Noviembre | 2 | 8 | 10 |
| 2019 Octubre | 0 | 1 | 1 |
| 2019 Septiembre | 0 | 4 | 4 |
| 2019 Agosto | 0 | 1 | 1 |
| 2019 Julio | 0 | 8 | 8 |
| 2019 Junio | 0 | 18 | 18 |
| 2019 Mayo | 1 | 57 | 58 |
| 2019 Abril | 0 | 12 | 12 |
| 2019 Marzo | 0 | 7 | 7 |
| 2019 Febrero | 0 | 8 | 8 |
| 2019 Enero | 0 | 1 | 1 |
| 2018 Diciembre | 0 | 7 | 7 |
| 2018 Marzo | 2 | 1 | 3 |
| 2018 Febrero | 15 | 4 | 19 |
| 2018 Enero | 15 | 7 | 22 |
| 2017 Diciembre | 17 | 10 | 27 |
| 2017 Noviembre | 18 | 2 | 20 |
| 2017 Octubre | 11 | 3 | 14 |
| 2017 Septiembre | 16 | 8 | 24 |
| 2017 Agosto | 24 | 4 | 28 |
| 2017 Julio | 27 | 1 | 28 |
| 2017 Junio | 29 | 7 | 36 |
| 2017 Mayo | 25 | 8 | 33 |
| 2017 Abril | 24 | 6 | 30 |
| 2017 Marzo | 30 | 6 | 36 |
| 2017 Febrero | 21 | 5 | 26 |
| 2017 Enero | 25 | 11 | 36 |
| 2016 Diciembre | 32 | 9 | 41 |
| 2016 Noviembre | 24 | 6 | 30 |
| 2016 Octubre | 25 | 11 | 36 |
| 2016 Septiembre | 27 | 11 | 38 |
| 2016 Agosto | 25 | 5 | 30 |
| 2016 Julio | 29 | 18 | 47 |
| 2016 Junio | 10 | 4 | 14 |
| 2016 Mayo | 9 | 15 | 24 |
| 2016 Abril | 8 | 4 | 12 |
| 2016 Marzo | 5 | 14 | 19 |
| 2016 Febrero | 5 | 9 | 14 |
| 2016 Enero | 11 | 12 | 23 |
| 2015 Diciembre | 12 | 9 | 21 |
| 2015 Noviembre | 9 | 4 | 13 |
| 2015 Octubre | 8 | 4 | 12 |
| 2015 Septiembre | 3 | 3 | 6 |
| 2015 Agosto | 10 | 1 | 11 |
| 2015 Julio | 32 | 10 | 42 |
| 2015 Junio | 35 | 6 | 41 |
| 2015 Mayo | 63 | 16 | 79 |
| 2015 Abril | 33 | 13 | 46 |
| 2015 Marzo | 44 | 9 | 53 |
| 2015 Febrero | 23 | 11 | 34 |
| 2015 Enero | 27 | 21 | 48 |
| 2014 Diciembre | 31 | 10 | 41 |
| 2014 Noviembre | 21 | 16 | 37 |
| 2014 Octubre | 39 | 16 | 55 |
| 2014 Septiembre | 33 | 15 | 48 |
| 2014 Agosto | 50 | 25 | 75 |
| 2014 Julio | 43 | 25 | 68 |
| 2014 Junio | 50 | 18 | 68 |
| 2014 Mayo | 42 | 22 | 64 |
| 2014 Abril | 39 | 20 | 59 |
| 2014 Marzo | 62 | 19 | 81 |
| 2014 Febrero | 29 | 12 | 41 |
| 2014 Enero | 49 | 20 | 69 |
| 2013 Diciembre | 38 | 18 | 56 |
| 2013 Noviembre | 35 | 14 | 49 |
| 2013 Octubre | 25 | 21 | 46 |
| 2013 Septiembre | 24 | 19 | 43 |
| 2013 Agosto | 25 | 31 | 56 |
| 2013 Julio | 30 | 32 | 62 |
| 2013 Junio | 28 | 27 | 55 |
| 2013 Mayo | 24 | 30 | 54 |
| 2013 Abril | 27 | 18 | 45 |
| 2013 Marzo | 30 | 25 | 55 |
| 2013 Febrero | 24 | 13 | 37 |
| 2013 Enero | 13 | 3 | 16 |
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