Evaluation of the appropriateness of plain chest film in chronic diseases.

Objective: To improve continuity of care and appropriateness of plain chest film orders in patients suffering from chronic diseases (hypertension, chronic obstructive pulmonary disease (COPD) and lung tuberculosis.

Design: Retrospective evaluation study using explicit and normative consensued criteria.

Setting: Urban health center.

Results: Compliance with the continuity criteria was 48%, 65% and 76% in three successive evaluations. Compliance with the appropriateness criteria was 52% and 62%. Orders from patients with COPD were responsible for most of the lack of compliance. Causes of non-compliance with the continuity criteria were attitude and organizational problems; with regard to appropriateness, the main cause was external to the Health Center.

Conclusions: (1) Difficulty in improving registers, reflecting a defect in the continuity of care. (2) Usefulness of evaluation in discovering the causes of the problems, in these cases an external one. (3) Difficulty of improvement when the cause of the problem is external to our own setting. (4) Partial effectiveness of continuing education measures because of professional changes in the Health Center.