Advertisement

Validity of diagnoses of chronic diseases in general practice

The application of diagnostic criteria
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Certainty of a diagnosis is not only important for the patient but also for morbidity studies. In the absence of a gold standard, agreement with diagnostic criteria is often the best approach in measuring the certainty of a diagnosis. The agreement with diagnostic criteria has been studied for 5 chronic diseases (hypertension, chronic ischemic heart disease, diabetes mellitus, chronic nonspecific lung disease and osteoarthritis) in 7 general practices with a total practice population of 23,534 persons. Agreement with diagnostic criteria is operationalized into 3 categories. For each chronic disease a diagnostic quality measure per general practitioner is computed. Retrospective data have been collected in the practices on 2295 diseases in 1989 patients. Two-thirds of the diagnoses were made in general practice. The agreement with the diagnostic criteria for the cases diagnosed in general practice is high, ranging from 96% true positive cases in diabetes mellitus to 58% in chronic nonspecific lung disease. The highest rate of false positive cases is 4%. On the level of general practitioners diagnostic qualities vary from 62 to 96% true positive cases for the different diseases. The variation in diagnostic quality between general practitioners is substantial. The prevalence rates for the 5 chronic diseases are lower after adjustment by only including true positive cases. Diagnoses of the 5 chronic diseases recorded in general practice are generally valid with low numbers of false positive cases.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Clinical Epidemiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hasler J.C.
        The very stuff of general practice.
        J R Coll Gen Pract. 1985; 35: 121-127
      1. Hasler J. Schofield T. Continuing Care: the Management of Chronic Disease. 2nd edn. Oxford University Press, Oxford1990
      2. Grol R. Mesker P. Schellevis F. Peer Review in General Practice. Meditekst, Lelystad1987
        • Campen C.v.
        • Sluijs E.M.
        Patient compliance. A survey of reviews (1979–1989).
        ([Bibliography]) Netherlands Institute of Primary Health Care, Utrecht1989
        • Kars-Marshall C.
        • Spronk-Boon Y.W.
        • Pollemans M.C.
        National health interview surveys for health care policy.
        Soc Sci Med. 1988; 26: 223-234
        • Tretli S.
        • Lund-Larsen P.G.
        • Foss O.P.
        Reliability of questionnaire information on cardiovascular disease and diabetes: cardiovascular disease study in Finnmark county.
        J Epidemiol Common Health. 1982; 36: 269-273
        • Midthjell K.
        • Holmen J.
        • Bjørndal A.
        • Lund-Larsen P.G.
        Is questionnaire information valid in the study of a chronic disease such as diabetes? The Nord-Trøndelag diabetes study.
        J Epidemiol Commun Health. 1992; 46: 537-542
        • Classification Committee of WONCA
        International Classification of Health Problems in Primary Care (ICHPPC)-2-Defined.
        3rd edn. Oxford University Press, Oxford1983
        • Huijnen L.G.J.
        • Muyrers P.E.M.
        • Knottnerus J.A.
        Registreren van diagnosen met behulp van diagnostische criteria.
        Huisarts Wet. 1987; 30 (English Summary): 237-239
        • Foets M.
        • Velden J.vd.
        • Bakker D.de
        Dutch National Survey of General Practice. Survey Design.
        Netherlands Institute of Primary Health Care, Utrecht1992
        • Whiting-O'Keefe Q.E.
        • Henke C.
        • Simborg D.W.
        Choosing the correct unit of analysis in medical care experiments.
        Med Care. 1984; 22: 1101-1114
        • WHO Expert Committee on Diabetes Mellitus
        4th edn. Technical Report Series No. 646. WHO, Geneva1980
        • Hoogen H.J.M.vd
        • Huygen F.J.A.
        • Schellekens J.W.G.
        • Straat J.M.
        • Velden H.G.M.vd
        Morbidity Figures from General Practice. Data from Four General Practices.
        Nijmegen University Department of General Practice, Nijmegen1985
        • Lamberts H.
        Morbidity in General Practice. Diagnosis Related Information from the Monitoring Project.
        Huisartsenpers, Utrecht1984
        • Sluiter H.J.
        • Koëter G.H.
        • Monchy J.G.R.de
        • Postma D.S.
        • Vries K.de
        • Orie N.G.M.
        The Dutch hypothesis (chronic non-specific lung disease) revisited.
        Eur Respir J. 1991; 4: 479-489
        • Vermeire P.A.
        • Pride N.B.
        A “splitting” look at chronic nonspecific lung disease (CNSLD): common features but diverse pathogenesis.
        Eur Respir J. 1991; 4: 490-496
        • Mant D.
        • Tulloch A.
        Completeness of chronic disease registration in general practice.
        Br Med J. 1987; 294: 223-224