title: Why don't they listen? Adherence to recommendations of infectious disease consultations.
abstract: The effectiveness of an infectious diseases (ID) consultation is dependent on adherence to the recommendations. To delineate the factors that affect adherence, we conducted a prospective cohort study of 465 consultations at 2 academic institutions in which we evaluated the consultation process, patient and consultant characteristics, types of recommendations, and compliance with recommendations. The overall compliance rate was 80%, with 85% adherence to crucial recommendations. Multivariate analysis revealed that adherence to ID recommendations was higher when the recommendations were therapeutic instead of diagnostic, when they related to a specific clinical question, when recommendations were deemed crucial by the ID service, if the primary service was medicine, and if the consultation note was legible and organized. Whether modification of consultant practice will lead to improved recommendation compliance and patient outcomes warrants further study.
authors.affiliation: John H. Stroger Jr. Hospital of Cook County, Rush-PresbyterianSt Luke's Medical Center, and Rush Medical College, Chicago, Illinois, USA. elo@sbgh.mb.ca
authors.forename: Evelyn
authors.initials: E
authors.lastname: Lo
authors.forename: Katayoun
authors.initials: K
authors.lastname: Rezai
authors.forename: Arthur T
authors.initials: AT
authors.lastname: Evans
authors.forename: Miguel G
authors.initials: MG
authors.lastname: Madariaga
authors.forename: Martin
authors.initials: M
authors.lastname: Phillips
authors.forename: Wahab
authors.initials: W
authors.lastname: Brobbey
authors.forename: David N
authors.initials: DN
authors.lastname: Schwartz
authors.forename: Yue
authors.initials: Y
authors.lastname: Wang
authors.forename: Robert A
authors.initials: RA
authors.lastname: Weinstein
authors.forename: Gordon M
authors.initials: GM
authors.lastname: Trenholme
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003141:Communicable Diseases / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D019983:Guideline Adherence; D006287:Health Planning Guidelines; D006761:Hospitals; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D010349:Patient Compliance; D011446:Prospective Studies; D012017:Referral and Consultation