IMPROVING PULMONARY AUSCULTATION AS A TOOL IN THE DIAGNOSIS OF BRONCHIAL OBSTRUCTION - RESULTS OF AN EDUCATIONAL INTERVENTION

Objective - To study the effect of an eduational intervention ail gene ral practitioners' (GPs') ability to diagnose bronchial obstruction af ter clinical examination. Design - Based on physical chest examination 11 GPs assessed the degree of bronchial obstruction by estimating the patient's predicted forced expiratory volume in one second (FEV1%). H alf way in the study the GPs were taught new knowledge on associations : between lung sounds and bronchial airflow. The agreements between es timated and measured FET1% predicted before and after this educational intervention were compared. Setting - 11 GPs in five health centres i n northern Norway took part. Patients - 351 adult patients were includ ed in phase 1, and 341 in phase 2. Main outcome measures - Estimated a nd measured FEV1% predicted were compared in subgroups of patients acc ording to clinical findings in phase 1 and 2. The effect of the interv ention on the doctors' weighting of various chest signs could thus be evaluated. Kappa agreement and correlation between estimated and measu red FEV1% predicted in both phases were determined. Results - The agre ement between estimated and measured FEV1% predicted increased from K- w (weighted Kappa) = 0.33 in phase I to K-w = 0.43 in phase 2 (95% con fidence interval 0.35-0.52). The GPs laid more relevant emphasis on rh onchi in their estimates after the educational intervention, while too much weight was laid on uncertain chest findings in phase 2. Conclusi on - The study shows a potential for better use of physical chest exam ination in the diagnosis of bronchial obstruction.