The yield of a diagnostic hospital dyspnoea clinic for the primary health care section

Abstract

Objective: To investigate the impact of a combined examination programme with treatment advice on patients from general practice with dyspnoea.

Design: Prospective study with 6 months followup.

Setting: Regional hospital offering care for patients from 74 general practitioners.

Subjects: A total of 284 consecutive patients referred from general practice with dyspnoea.

Interventions: Patients were subjected to a combined examination programme including physical examination, ECG, chest X-ray, lung spirometry, echocardiography and routine laboratory tests.

Main outcome measures: (i) Relationship between a diagnosis made by the referring general practitioner and the diagnosis based on the combined examination programme. (ii) The impact of the investigation programme and resulting therapeutic advice on dyspnoea after 6 months.

Results: Only in 39% of the patients there was concordance of the diagnoses on referral and the diagnosis based on the examination programme. Heart failure and lung disease was suspected in 126 and 79 patients, respectively, but these diagnoses were confirmed in only one-third to half of the patients. Conversely heart failure was revealed in 13 of 107 patients not suspected of heart failure (12%) and lung disease in 45 of 154 patients not suspected of pulmonary disease (29%). A change of treatment was suggested in 64% of all patients. After 6 months, improvement of dyspnoea was seen in more than half of the patients. In patients in whom the changes of medical treatment were completed, 61% expressed improvement in dyspnoea, whereas improvement of dyspnoea was recorded in only 34% of patients in whom the recommended treatment advice was not taken (P < 0.01).

Conclusion: (i) In most patients it seems to be too difficult to establish the background of dyspnoea in general practice. (ii) There appears to be a substantial chance of improvement in patients with dyspnoea, in particular for patients who act on treatment advice based on an integrated examination programme; the chance of improvement is almost twice as good as in patients who are not capable to do so.