De waarde van een astma-adviespolikliniek*

Een effectieve service voor patiënt én huisarts
Onderzoek
03-07-2018
Ruby M.E. Gillis, Walter van Litsenburg, Roland H.H. van Balkom, Jean W. Muris en Frank W.J.M. Smeenk

The contribution of an asthma diagnostic consultation service in obtaining an accurate asthma diagnosis for primary care patients: results of a real-life study

Objective

Previous studies showed that general practitioners (GPs) have problems in diagnosing asthma accurately, resulting in both under and overdiagnosis. To support GPs in their diagnostic process an asthma diagnostic consultation service (ADCS) was set up.

Design

We evaluated the performance of this ADCS by analysing the (dis)concordance between the GPs working hypotheses and the ADCS diagnoses and possible consequences this had on the patients’ pharmacotherapy.

Method

In total 659 patients were included in this study. At this service the patients’ medical history was taken and a physical examination and a histamine challenge test were carried out. We compared the GPs working hypotheses with the ADCS diagnoses and the change in medication this incurred.

Results

In 52% (n = 340) an asthma diagnosis was excluded. The diagnosis was confirmed in 42% (n = 275). Furthermore, chronic rhinitis was diagnosed in 40% (n = 261) of the patients whereas this was noted in 25% (n = 163) by their GP. The adjusted diagnosis resulted in a change of medication for more than half of all patients. In 10% (n = 63) medication was started because of a new asthma diagnosis. The ‘one-stop-shop’ principle was met with 53% of patients and 91% (n = 599) were referred back to their GP, mostly within 6 months. Only 6% (n = 41) remained under control of the ADCS because of severe unstable asthma.

Conclusion

In conclusion, the ADCS helped GPs significantly in setting accurate diagnoses for their patients with an asthma hypothesis. This may contribute to diminish the problem of over and underdiagnosis and may result in more appropriate treatment regimens.

Conflict of interest and financial support: none declared.