title: Home management of mild to moderately severe community-acquired pneumonia: a randomised controlled trial.
abstract: OBJECTIVE
  To determine whether community management of mild to moderate community-acquired pneumonia (CAP) is as effective and acceptable as standard hospital management of CAP.
  
  
  METHODS
  Randomised controlled trial.
  
  
  METHODS
  Christchurch, New Zealand, primary and secondary care.
  
  
  METHODS
  55 patients presenting or referred to the emergency department at Christchurch Hospital with mild to moderately severe pneumonia, assessed using a validated pneumonia severity assessment score, from July 2002 to October 2003.
  
  
  METHODS
  Hospital treatment as usual or comprehensive care in the home delivered by primary care teams.
  
  
  METHODS
  Primary: days to discharge, days on intravenous (IV) antibiotics, patient-rated symptom scores. Secondary: health status measured using level of functioning at 2 and 6 weeks, patient satisfaction.
  
  
  RESULTS
  The median number of days to discharge was higher in the home care group (4 days; range, 1-14) than in the hospital groups (2 days; range, 0-10; P = 0.004). There was no difference in the number of days on IV antibiotics or on subsequent oral antibiotics. Patient-rated symptom scores at 2 and 6 weeks, median change in symptom severity from baseline to 6 weeks, and general functioning at 2 and 6 weeks did not differ between the groups. Patients in both groups were satisfied with their treatment, with a clear preference for community treatment (P < 0.001).
  
  
  CONCLUSIONS
  Mild to moderately severe CAP can be managed effectively in the community by primary care teams. This model of comprehensive care at home can be implemented by primary care teams with suitable funding structures.
authors.affiliation: Christchurch School of Medicine and Health Sciences, PO Box 4345, Christchurch, New Zealand. derelie.richards@chmeds.ac.nz
authors.forename: Dee A
authors.initials: DA
authors.lastname: Richards
authors.forename: Les J
authors.initials: LJ
authors.lastname: Toop
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Epton
authors.forename: Graham R B
authors.initials: GR
authors.lastname: McGeoch
authors.forename: G Ian
authors.initials: GI
authors.lastname: Town
authors.forename: Simon M H
authors.initials: SM
authors.lastname: Wynn-Thomas
authors.forename: Robin D
authors.initials: RD
authors.lastname: Dawson
authors.forename: Michael C
authors.initials: MC
authors.lastname: Hlavac
authors.forename: Anja M
authors.initials: AM
authors.lastname: Werno
authors.forename: Paul D
authors.initials: PD
authors.lastname: Abernethy
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000382:microbiology / Q000451:nursing; D003362:Cost-Benefit Analysis; D005260:Female; D006699:Home Care Services / Q000191:economics; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009177:Mycoplasma pneumoniae / Q000302:isolation & purification; D009520:New Zealand; D010043:Outcome and Process Assessment, Health Care; D017060:Patient Satisfaction; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000451:nursing*; D011019:Pneumonia, Mycoplasma / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000451:nursing; D011018:Pneumonia, Pneumococcal / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000451:nursing; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents