Basic assessment of chronic cough in primary care and referral pathways of patients to different specialists.

IF 3.3 3区 医学 Q2 RESPIRATORY SYSTEM
Christian Domingo, Jaime Gonzálvez, Ignacio Dávila, Alfonso Del Cuvillo, Marta Sánchez-Jareño, Luis Cea-Calvo, Karlos Naberán
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引用次数: 1

Abstract

Background: Chronic cough (CC; cough that lasts 8 weeks or longer) poses major effective assessment challenges. Assessment of CC may vary considerably among medical specialists.

Objectives: The aim was to evaluate similarities and consistency of responses across different specialists when performing a basic assessment of CC patients in primary care, and referring patients based on clinical findings or test results.

Methods: A modified Delphi approach was used. A survey with 74 statements on initial assessment of CC and referral pathways was addressed to a panel of different specialists, who voted the statements in two rounds.

Results: Seventy-seven physicians [18 primary care physicians (PCPs), 24 pulmonologists, 22 allergists, and 13 ear, nose, and throat specialists] from the National Healthcare System of Spain answered the questionnaire. After two rounds, the panel reached a consensus on 63 out of the 74 proposed items (85.1%). Consensus was not reached among the panelists of at least one specialty on 15 out of these 63 agreed items. The panel agreed on those clinical aspects that should be evaluated by PCPs in all patients with CC including the impact of CC on quality of life. Agreement was reached on initial actions to be taken in primary care, including substitution of drugs that may induce cough, performing a chest X-ray, introduction of anti-reflux measures, initiation of empirical anti-reflux pharmacological therapy in some cases, and performing a spirometry with bronchodilator test and hemogram if an etiological diagnosis was not reached. The panelists agreed on a list of diseases that PCPs should assess before referring CC patients. Algorithms were developed for initial assessment and targeted referral of patients with CC from primary care.

Conclusion: This study provides the perspective of different medical specialists on how to perform a basic assessment of CC patients in primary care and how and when to refer patients to other specialists.

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慢性咳嗽在初级保健的基本评估和转诊途径的病人到不同的专家。
背景:慢性咳嗽(CC;咳嗽持续8周或更长时间)是有效评估的主要挑战。医学专家对CC的评估可能有很大差异。目的:目的是评估不同专家在初级保健中对CC患者进行基本评估时反应的相似性和一致性,并根据临床发现或测试结果转诊患者。方法:采用改进的德尔菲法。一份关于CC初步评估和转诊途径的74份声明的调查被提交给了一个由不同专家组成的小组,他们分两轮对这些声明进行投票。结果:来自西班牙国家卫生保健系统的77名医生[18名初级保健医生(pcp), 24名肺科医生,22名过敏症专家,13名耳鼻喉科专家]回答了问卷。经过两轮协商,在74项提案中的63项(85.1%)达成了共识。在这63个商定项目中的15个上,至少一个专业的小组成员没有达成协商一致意见。专家组就pcp应评估所有CC患者的临床方面达成一致,包括CC对生活质量的影响。就在初级保健中应采取的初步行动达成一致,包括替代可能诱发咳嗽的药物,进行胸部x光检查,引入抗反流措施,在某些情况下开始经验性抗反流药物治疗,如果无法获得病因诊断,则进行肺活量测定并进行支气管扩张试验和血象检查。专家组成员就pcp在转诊CC患者之前应评估的疾病清单达成一致。开发了用于初级保健的CC患者的初始评估和定向转诊的算法。结论:本研究提供了不同医学专家关于如何在初级保健中对CC患者进行基本评估以及如何以及何时将患者转诊给其他专家的观点。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.90
自引率
0.00%
发文量
57
审稿时长
15 weeks
期刊介绍: Therapeutic Advances in Respiratory Disease delivers the highest quality peer-reviewed articles, reviews, and scholarly comment on pioneering efforts and innovative studies across all areas of respiratory disease.
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