The HCAP gap: differences between self-reported practice patterns and published guidelines for health care-associated pneumonia.
BACKGROUND
Health care-associated pneumonia (HCAP) is prevalent among hospitalized patients. In contrast to community-acquired pneumonia (CAP), patients with HCAP are at increased risk for multidrug-resistant organisms, and appropriate initial antibiotic therapy is associated with reduced mortality.


METHODS
An online survey was distributed to faculty and housestaff at 4 academic medical centers. The survey required respondents to choose initial antibiotic therapy for 9 hypothetical pneumonia cases (7 cases of HCAP and 2 cases of CAP). Answers were considered correct if the antibiotic regimen chosen was consistent with published guidelines. In addition, physicians rated their knowledge of current guidelines, as well as their level of agreement with guideline recommendations.


RESULTS
Surveys were sent to 1313 physicians with a response rate of 65% (n = 855). Respondents included physicians in the following categories: hospital medicine/internal medicine, 60%; emergency medicine, 25%; and critical care, 13%. Respondents selected guideline-concordant antibiotic regimens 78% of the time for CAP, but only 9% of the time for HCAP. Because mean scores for HCAP questions were extremely low (mean, 0.63 correct answers out of 7), differences in performance between groups were too small to be meaningful. Despite their poor performance, 71% of the respondents stated that they are aware of published guidelines for HCAP, and 79% stated that they agree with and practice according to the guidelines.


CONCLUSIONS
In this survey, physicians reported they were aware of, agreed with, and practiced according to published pneumonia guidelines; however, the overwhelming majority did not choose guideline-concordant therapy when tested.
Seymann
Gregory B
GB
Division of Hospital Medicine, Department of Medicine, University of California-San Diego, CA 92103-8485, USA. gseymann@ucsd.edu
Di Francesco
Lorenzo
L
Sharpe
Bradley
B
Rohde
Jeffrey
J
Fedullo
Peter
P
Schneir
Aaron
A
Fee
Christopher
C
Chan
Kevin M
KM
Fatehi
Pedram
P
Dam
Thuy-Tien
TT
D000046:Academic Medical Centers; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy*; D006801:Humans; D011014:Pneumonia / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'
D000900:Anti-Bacterial Agents