Assessing, treating and preventing community acquired pneumonia in older adults: findings from a community-wide survey of emergency room and family physicians.
BACKGROUND
Respiratory infections, like pneumonia, represent an important threat to the health of older Canadians. Our objective was to determine, at a community level, family and emergency room physicians' knowledge and beliefs about community acquired pneumonia (CAP) in older adults and to describe their self-reported assessment, management and prevention strategies.


METHODS
All active ER and family physicians in Brant County received a mailed questionnaire. An advance notification letter and three follow-up mailings were used to maximize physician participation rate. The questionnaire collected information about physicians' assessment, management, and prevention strategies for CAP in older adults (>or=60 years of age) plus demographic, training, and practice characteristics. The analysis highlights differences in approaches between office-based and emergency department physicians.


RESULTS
Seventy-seven percent of physicians completed and returned the survey. Although only 16% of physicians were very confident in assessing CAP in older adults, more than half reported CAP to be a very important health concern in their practices. In-service training for family physicians was associated with increased confidence in CAP assessment and more frequent use of diagnostic tests. Family physicians who reported always requesting chest x-rays were also more likely to request pulse oximetry (OR 5.6, 95% CI 1.40 to 22.5) and recommend both follow-up x-rays (OR 5.4, 95% CI 1.7 to 16.6) and pneumococcal vaccination (OR 3.4, 95% CI 1.1 to 10.0).


CONCLUSIONS
The findings of this study provide a snapshot of how non-specialists from a non-urban Ontario community assess, manage and prevent CAP in older adults and highlight differences between office-based and emergency department physicians. This information can guide researchers and clinicians in their efforts to improve the management and prevention of CAP in older adults.
Krueger
Paul
P
St, Joseph's Health System Research Network, Father Sean O'Sullivan Research Centre, Hamilton, Ontario, Canada. kruegerp@mcmaster.ca
Loeb
Mark
M
Kelly
Caralyn
C
Edward
H Gayle
HG
D000368:Aged; D002983:Clinical Competence; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000517:prevention & control / Q000628:therapy; D016001:Confidence Intervals; D004636:Emergency Service, Hospital / Q000592:standards*; D005194:Family Practice / Q000592:standards*; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D009819:Office Visits; D009864:Ontario; D011014:Pneumonia / Q000175:diagnosis* / Q000517:prevention & control / Q000628:therapy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires