Nov - Dez - English - 2014

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José BPS et al.
600 Rev Assoc Med Bras 2014; 60(6):599-612
diagnostic ability and the elaboration of treatment plans
for these conditions by PHC physicians, as well as the fac-
tors influencing them.
This article presents a review of the literature with
respect to the diagnostic accuracy of general physicians
in PHC in relation to the most prevalent respiratory di-
seases and those of greatest interest for public health, in-
cluding ARI, tuberculosis, asthma and COPD.
Methods
A search of the literature was undertaken for articles as-
sessing the concordance between the diagnosis by PHC
physicians and specialists in respiratory diseases for the
main respiratory illnesses in PHC services. The review also
included studies using supplementary reference exams
(spirometry) for asthma and COPD; acid-fast bacilli (AFB)
tests for tuberculosis and C-reactive protein (CRP) and
procalcitonin for ARI or for making clinical decisions,
such as prescribing antibiotics.
The literature review was conducted using the PUB-
MED database covering the period from 1/1/1992 to
8/1/2012, limited to studies conducted on humans and
published in Portuguese, English and Spanish.
In the selection, cross-referencing was performed using
these groups of MeSH keywords with free terms (FT) of re-
levance to the research: “diagnosis” (MeSH), “underdiagno-
sis” (TL) e “diagnostic concordance” (TL) com “respiratory
tract infections” (MeSH), “asthma” (MeSH), “COPD” (MeSH)
and “tuberculosis” (MeSH) with “primary health care”
(MeSH) and “general practitioners” (MeSH; Figure 1).
As a result of the lack of studies about this issue in
the literature, differences in methodology or the defini-
tions of conditions were not used as exclusion criteria, as
will be discussed below.
The diseases included in this review were ARI, asth-
ma, COPD and tuberculosis. Articles that included other
diseases such as sleep apnea, lung cancer and other res-
piratory diseases were excluded.
Diagnosis
Asthma
COPD
Respiratory tract
infections
Diagnostic
concordance
Underdiagnosis
Tuberculosis
General practitioners
Primary health
care
Primary health
care
Primary health
care
Primary health
care
General practitioners
General practitioners
General practitioners
951
226
953
235
118
505
55
70
60
14
19
4
2
4
0
5
7
7
1
1
1
0
0
675
Figure 1System for searching articles according to the keywords and number of articles found in each cross-reference.