Diagnostic agreement between primary care physicians and dermatologists in the health area of a referral hospital

Abstract

Introduction. Skin diseases account for a high proportion of presenting complaints in primary health care. In Spain, the growing demand for consultations and the resulting longer waiting lists make it necessary to establish criteria for appropriate referrals to a specialist. This study aimed to investigate the characteristics of referrals from primary care centers to dermatology specialists as well as the correlation between the presenting complaint and the final dermatologic diagnosis. Patients and methods. We collected data from 3164 patients seen for the first time by dermatologists in our specialist service during 1998. Patients were stratified according to the referring primary health care center and the reason for referral. The agreement between the presenting complaint and the final dermatologic diagnosis was studied. For each dermatologic condition, the positive predictive value, diagnostic sensitivity, and κ statistic were calculated. Results. The overall diagnostic agreement was 65.52 %. Primary care physicians were found to overdiagnose diseases caused by papillomavirus and the diagnostic sensitivity was very low for diseases such as basal cell carcinoma and seborrheic keratosis. Conclusions. It is necessary to insist on training primary care physicians, ensuring appropriate referral from primary health care clinics, and promoting an effective dialogue with the specialist.