Why don't they listen? Adherence to recommendations of infectious disease consultations.
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.
Lo
Evelyn
E
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
Rezai
Katayoun
K
Evans
Arthur T
AT
Madariaga
Miguel G
MG
Phillips
Martin
M
Brobbey
Wahab
W
Schwartz
David N
DN
Wang
Yue
Y
Weinstein
Robert A
RA
Trenholme
Gordon M
GM
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