Nov - Dez - English

iagnostic

accuracy

respiratory

diseases

primary

health

units

ssoc

ras

2014; 60(6):599-612

611

tion, where the lack of a medical diagnosis will result in

increased morbidity or the occurrence of acute and chro-

nic complications. Specialists have a supporting role in

the diagnosis and monitoring of the more complex cases.

The detection process should be primarily the responsi-

bility of primary care, which presupposes adequate trai-

ning of GPs and the implementation of a horizontal care

program including the provision of medication and

supplementary exams to diagnostics so that respiratory

diseases can be identified and treated at an early stage.

This review includes some limitations which should

be discussed. Some studies about ARI only compared

prescriptions for antibiotics and did not verify the qua-

lity and accuracy of the diagnosis.

11,12,14

Other works as-

sessed accuracy as a secondary outcome.

Methodologi-

cal differences within the same group may have

compromised these results, at least in part. Various dif-

ferences can be highlighted, since the stage of inclusion

criteria: database or spontaneous demand reviews, age,

history of smoking, through to definition of the COPD

diagnosis, with some using the GOLD 1 (FEV1/FVC <70)

criteria , others GOLD 2 (FEV1/FVC <70 and FEV1 <80%),

while in others the criteria were not clearly defined. Ano-

ther limitation that can be cited is the extraction of data

by a single researcher, which may have affected the repro-

ducibility of the results.

onclusion

The results prove, in a general manner, that there are diag-

nostic errors and that the level of knowledge of respiratory

diseases by general practitioners in various countries is lower

than desired. To better understand the reality of healthcare

in PHC, further studies with methodologies better defined

regarding inclusion criteria and assessment tools, should be

conducted. Their results could support the adoption of con-

sistent policies for improving healthcare as a whole.

esumo

Precisão diagnóstica de doenças respiratórias em unida-

des primárias de saúde.

As doenças respiratórias acometem 15% da população

do planeta e respondem por 1/5 dos óbitos no mundo.

Espera-se que a atenção primária à saúde (APS), primei-

ra instância da assistência médica, solucione até 85%

dos problemas de saúde em geral. Pouco se sabe a res-

peito da habilidade de médicos generalistas da APS em

relação ao diagnóstico das doenças respiratórias. Esta

revisão refere-se à habilidade diagnóstica de médicos ge-

neralistas que atuam na APS em relação às doenças res-

piratórias mais prevalentes, como doenças respiratórias

agudas (IRA), tuberculose, asma e doença pulmonar obs-

trutiva crônica (DPOC). Dentre 3.913 artigos, 30 foram

selecionados após aplicação dos critérios de inclusão e

exclusão. Ficou demonstrada a carência de dados con-

sistentes sobre a acurácia dos diagnósticos de doenças

respiratórias elaborados por generalistas. Em relação à

asma e à DPOC, os estudos demonstram erros diagnós-

ticos que levam ao sobrediagnóstico ou ao subdiagnós-

tico, dependendo da metodologia usada. A imprecisão

do diagnóstico de asma variou de 54% de subdiagnósti-

co a 34% de sobrediagnóstico; para DPOC, houve varia-

ção de 81% de subdiagnóstico a 86,1% de sobrediagnós-

tico; para IRA, verificou-se que a inclusão de exame

complementar de auxílio diagnóstico melhora sua acu-

rácia. Os estudos demonstram um baixo nível de conhe-

cimento sobre tuberculose por parte dos generalistas.

De acordo com esta revisão, a APS, na figura do médico

generalista, necessita aprimorar sua capacidade de diag-

nóstico e o manejo desse grupo de pacientes, que cons-

titui uma de suas principais demandas.

Palavras-chave:

doenças respiratórias; atenção primária

à saúde; diagnóstico; médicos de atenção primária; revisão.

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