The yield of a diagnostic hospital dyspnoea clinic for the primary health care section

• Published in: Journal of internal medicine 2001-11, Vol.250 (5), p.422-428
• Main Authors: Nielsen, L. Svendstrup, Svanegaard, J., Wiggers, P., Egeblad, H.
• Format: Article
• Language: English
• Subjects: access to health care; Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Diagnostic Services; Dyspnea - diagnosis; Dyspnea - etiology; Dyspnea - therapy; dyspnoea; Family Practice; Female; Follow-Up Studies; heart failure; Heart Failure - complications; Heart Failure - diagnosis; Hospitals; Humans; lung disease; Lung Diseases - complications; Lung Diseases - diagnosis; Male; Medical sciences; Middle Aged; Pneumology; Primary Health Care; Program Evaluation; Prospective Studies; Referral and Consultation; Respiratory system : syndromes and miscellaneous diseases
• ISSN: 0954-6820; 1365-2796
• DOI: 10.1046/j.1365-2796.2001.00901.x

. Svendstrup Nielsen L, Svanegaard J, Wiggers P, Egeblad H (Haderslev Hospital; Aarhus University Hospital, Skejby, Denmark). The yield of a diagnostic hospital dyspnoea clinic for the primary health care section. J Intern Med 2001; 250: 422–428. Objective. To investigate the impact of a combined examination programme with treatment advice on with dyspnoea. Design. Prospective study with 6 months follow‐up. Setting. Regional hospital offering care for patients from 74 general practitioners. Subjects. A total of 284 consecutive patients referred from general practice with dyspnoea. Interventions. Patients were subjected to a combined examination programme including physical examination, ECG, chest X‐ray, lung spirometry, echocardiography and routine laboratory tests. Main outcome measures. (i) Relationship between a diagnosis made by the referring general practitioner and the diagnosis based on the combined examination programme. (ii) The impact of the investigation programme and resulting therapeutic advice on dyspnoea after 6 months. Results. Only in 39% of the patients there was concordance of the diagnoses on referral and the diagnosis based on the examination programme. Heart failure and lung disease was suspected in 126 and 79 patients, respectively, but these diagnoses were confirmed in only one‐third to half of the patients. Conversely heart failure was revealed in 13 of 107 patients not suspected of heart failure (12%) and lung disease in 45 of 154 patients not suspected of pulmonary disease (29%). A change of treatment was suggested in 64% of all patients. After 6 months, improvement of dyspnoea was seen in more than half of the patients. In patients in whom the changes of medical treatment were completed, 61% expressed improvement in dyspnoea, whereas improvement of dyspnoea was recorded in only 34% of patients in whom the recommended treatment advice was not taken (P